中华关节外科杂志（电子版）
中華關節外科雜誌（電子版）
중화관절외과잡지（전자판）
CHINESE JOURNAL OF JOINT SURGERY(ELECTRONIC VERSION)
2012年
2期
44-47
,共4页
骨折%内固定器%治疗失败%髋%关节成形术%评价研究
骨摺%內固定器%治療失敗%髖%關節成形術%評價研究
골절%내고정기%치료실패%관%관절성형술%평개연구
Fractures,bone%Internal fixators%Treatment failure%Hip%Arthroplasty%Evaluation studies
目的 探讨股骨转子间骨折及股骨颈骨折复位内固定失败后全髋关节置换术临床疗效及影响因素.方法 自1998年8月至2009年3月,本组收治股骨转子间骨折及股骨颈骨折复位内固定失败患者21例,其中男11例,女10例,年龄37～87岁,平均66.3岁.其中股骨颈骨折12例,股骨转子间骨折9例.内固定种类:动力髋螺钉( DHS)5例,动力髁螺钉(DCS)2例,股骨近端髓内钉(PFN)1例,伽马钉2例,Hansson针1例,合并股骨上段粉碎性骨折行交锁钉内固定1例,空心钉9例.失败原因:股骨头坏死7例,骨折不愈合7例,不愈合合并股骨头坏死2例,钉松脱、切割致骨折移位或不愈合5例.以上21例内固定失败后致患肢缩短19例.置换术使用的皆为标准假体,无应用加长柄,无应力性骨折病例.假体类型:生物型6例,全骨水泥型4例,混合型11例.就术前术后功能改善、肢体长度恢复、手术并发症等进行评估,并分析其与患者年龄,两次手术间隔时间、术前肢体缩短畸形程度等因素间关系.结果 无住院死亡患者.随访中,4例死于系统性疾病.Harris 评分由全髋关节置换术前(27.53±2.96)分提高到置换术后最后一次随访(80.76±4.25)分.术前患肢缩短(2.67±1.06)cm,术后改善致(0.85±0.88)cm.患者年龄越轻,内固定失败后再次手术时间间隔越长,肢体缩短更严重,术中肢体长度的恢复也更困难.并发症:术后创伤性精神障碍1例,治疗后好转；术后脱位1例,麻醉下手法复位,外展支具固定6周；术中股骨上段劈裂骨折1例,无特殊处理.松动1例,翻修术后2年死于脑血管意外.结论 全髋关节置换术是髋部骨折内固定失败后有效的补救措施,宜尽早手术、并需因应病例个体病理改变情况,而相应作综合评估、考虑.
目的 探討股骨轉子間骨摺及股骨頸骨摺複位內固定失敗後全髖關節置換術臨床療效及影響因素.方法 自1998年8月至2009年3月,本組收治股骨轉子間骨摺及股骨頸骨摺複位內固定失敗患者21例,其中男11例,女10例,年齡37～87歲,平均66.3歲.其中股骨頸骨摺12例,股骨轉子間骨摺9例.內固定種類:動力髖螺釘( DHS)5例,動力髁螺釘(DCS)2例,股骨近耑髓內釘(PFN)1例,伽馬釘2例,Hansson針1例,閤併股骨上段粉碎性骨摺行交鎖釘內固定1例,空心釘9例.失敗原因:股骨頭壞死7例,骨摺不愈閤7例,不愈閤閤併股骨頭壞死2例,釘鬆脫、切割緻骨摺移位或不愈閤5例.以上21例內固定失敗後緻患肢縮短19例.置換術使用的皆為標準假體,無應用加長柄,無應力性骨摺病例.假體類型:生物型6例,全骨水泥型4例,混閤型11例.就術前術後功能改善、肢體長度恢複、手術併髮癥等進行評估,併分析其與患者年齡,兩次手術間隔時間、術前肢體縮短畸形程度等因素間關繫.結果 無住院死亡患者.隨訪中,4例死于繫統性疾病.Harris 評分由全髖關節置換術前(27.53±2.96)分提高到置換術後最後一次隨訪(80.76±4.25)分.術前患肢縮短(2.67±1.06)cm,術後改善緻(0.85±0.88)cm.患者年齡越輕,內固定失敗後再次手術時間間隔越長,肢體縮短更嚴重,術中肢體長度的恢複也更睏難.併髮癥:術後創傷性精神障礙1例,治療後好轉；術後脫位1例,痳醉下手法複位,外展支具固定6週；術中股骨上段劈裂骨摺1例,無特殊處理.鬆動1例,翻脩術後2年死于腦血管意外.結論 全髖關節置換術是髖部骨摺內固定失敗後有效的補救措施,宜儘早手術、併需因應病例箇體病理改變情況,而相應作綜閤評估、攷慮.
목적 탐토고골전자간골절급고골경골절복위내고정실패후전관관절치환술림상료효급영향인소.방법 자1998년8월지2009년3월,본조수치고골전자간골절급고골경골절복위내고정실패환자21례,기중남11례,녀10례,년령37～87세,평균66.3세.기중고골경골절12례,고골전자간골절9례.내고정충류:동력관라정( DHS)5례,동력과라정(DCS)2례,고골근단수내정(PFN)1례,가마정2례,Hansson침1례,합병고골상단분쇄성골절행교쇄정내고정1례,공심정9례.실패원인:고골두배사7례,골절불유합7례,불유합합병고골두배사2례,정송탈、절할치골절이위혹불유합5례.이상21례내고정실패후치환지축단19례.치환술사용적개위표준가체,무응용가장병,무응력성골절병례.가체류형:생물형6례,전골수니형4례,혼합형11례.취술전술후공능개선、지체장도회복、수술병발증등진행평고,병분석기여환자년령,량차수술간격시간、술전지체축단기형정도등인소간관계.결과 무주원사망환자.수방중,4례사우계통성질병.Harris 평분유전관관절치환술전(27.53±2.96)분제고도치환술후최후일차수방(80.76±4.25)분.술전환지축단(2.67±1.06)cm,술후개선치(0.85±0.88)cm.환자년령월경,내고정실패후재차수술시간간격월장,지체축단경엄중,술중지체장도적회복야경곤난.병발증:술후창상성정신장애1례,치료후호전；술후탈위1례,마취하수법복위,외전지구고정6주；술중고골상단벽렬골절1례,무특수처리.송동1례,번수술후2년사우뇌혈관의외.결론 전관관절치환술시관부골절내고정실패후유효적보구조시,의진조수술、병수인응병례개체병리개변정황,이상응작종합평고、고필.
Objective To evaluate clinical effects and the influence factors of total hip arthroplasty after reduction and fixation failure of the femoral inter-trochanteric fracture and femoral neck fracture.Methods Between Aug 1998 and Mar 2009,21 patients who underwent reduction and fixation failure of the femoral inter-trochanteric fracture ( 12 cases) and femoral neck fracture ( 11 cases) in our hospital were included in this study.11 were males and 10 were females,with age ranging from 37 to 87 years,66.3years in average.The internal fixation types included:five cases of DHS,two cases of DCS,one case of PFN,two cases of Gamma nail,one case of Hansson nail,one case combining the proximal femur comminuted fracture using internal fixation with interlocking nails,and nine cases of cannuiated screws.The reasons of failure were as follows:avascular necrosis of the femoral head in seven cases,fracture nonunion in seven cases,fracture nonunion with avascular necrosis of the femoral head in two cases,and fracture displacement or nonunion because of nail loosening or cutting in five cases.19 of 21 patients had shortened limbs because of fixation failure.Types of prosthesis:six of uncemented prothesis,four of cementedprothesis,11 of mixed type. The curative effects were evaluated by postoperation function improvement,restoration of extremity length,and incidence of complications.The relationships of age,the interval of two operations,limb legnth discrepancy,and clinical effects were also analyzed.Results No patients died in hospital,and four patients died because of systemic diseases in follow-up.Harris Hip Scores improved from 27.53 ± 2.96 to 80.76 ± 4.25 after THA in latest follow-up.Limb length discrepancy was 2.67 ± 1.06 cm preoperative,and was reduced to 0.85 ± 0.88 cm after operation.The younger the patients were,the longer the interval of reoperation was; the more severe the discrepancy before THA was,the more difficult the restoration of extremity length was.Complications were as follows:one case of postoperative traumatic mental disorders recovered after tremtment; one case of postoperative dislocation who had manual reduction under anesthetization and fixation with abduction braces for six weeks; one case of proximal femur cleavage fracture without treatment; one case of loosening who died of cerebrovascular accident two years after THA.Conclusions THA is an effective remedial method for internal fixation failure in the hip fracture and should be performed as soon as possible.It is necessary to make comprehensive evaluation and consideration according to individual pathological changes in different cases.
