中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2013年
12期
1143-1148
,共6页
郑如庚%董学宝%徐生产%马国驹%赵合意%张静
鄭如庚%董學寶%徐生產%馬國駒%趙閤意%張靜
정여경%동학보%서생산%마국구%조합의%장정
股骨颈骨折,老年人%关节成形术,置换,髋%对侧骨折
股骨頸骨摺,老年人%關節成形術,置換,髖%對側骨摺
고골경골절,노년인%관절성형술,치환,관%대측골절
Femoral neck fracture,aged%Arthroplasty,replacement,hip%Contralateral fractures
目的 探讨老年股骨颈骨折假体置换术后再发健侧股骨颈骨折的原因及治疗策略.方法 回顾性分析2005年3月-2012年5月收治的股骨颈骨折假体置换术后再发健侧股骨颈骨折,且有完整记录12例患者设为再次置换组;同期由同组医师完成的初次股骨颈骨折行假体置换术治疗的73例患者设为初次置换组,比较两组患者致伤原因、年龄、性别、骨密度、伴发病、生存质量评分、现患髋对侧关节Harris评分及术式选择情况,评估再骨折原因,提出治疗方案. 结果 两组患者的直接致伤原因均为跌倒;初次置换组和再次置换组比较:年龄分别为(68.82 ±5.18)岁、(76.83±3.64)岁(P＜0.05);男女性别构成比分别为0.66:1和0.09:1(P＜0.05);骨密度分别为(0.507 ±0.062)g/cm2、(0.461±0.095) g/cm2 (P＜0.05).高血压、糖尿病、白内障、脑卒中、类风湿性关节炎、帕金森病除糖尿病外,其余5种基础疾病的伴有率两组比较差异均有统计学意义(P＜0.05).生理领域生存质量评分初次置换组与再次置换组分别为(76.26±14.17)分、(67.86±16.74)分(P＜0.05);现患髋对侧关节Harris评分两组分别为(98.66±1.39)分、(90.75 ±5.39)分(P＜0.05).在治疗方式选择上,初次置换组中全髋关节置换术(total hip arthroplasty,THA)32例,单纯股骨头置换术(femoral head arthroplasty,FHA)41例,其中选用骨水泥型假体44例,生物型假体29例;再次置换组THA 2例,单纯FHA 10例,选用骨水泥型假体11例,生物型假体1例(P＜0.05). 结论 跌倒仍是老年人股骨颈骨折假体置换术后再发健侧骨折的直接原因,增龄、女性、骨密度降低、高伴发病、生存质量下降和初次假体置换后关节功能减退均是不利因素.假体置换仍是治疗首选,术式更倾向于选择骨水泥型单纯FHA.
目的 探討老年股骨頸骨摺假體置換術後再髮健側股骨頸骨摺的原因及治療策略.方法 迴顧性分析2005年3月-2012年5月收治的股骨頸骨摺假體置換術後再髮健側股骨頸骨摺,且有完整記錄12例患者設為再次置換組;同期由同組醫師完成的初次股骨頸骨摺行假體置換術治療的73例患者設為初次置換組,比較兩組患者緻傷原因、年齡、性彆、骨密度、伴髮病、生存質量評分、現患髖對側關節Harris評分及術式選擇情況,評估再骨摺原因,提齣治療方案. 結果 兩組患者的直接緻傷原因均為跌倒;初次置換組和再次置換組比較:年齡分彆為(68.82 ±5.18)歲、(76.83±3.64)歲(P＜0.05);男女性彆構成比分彆為0.66:1和0.09:1(P＜0.05);骨密度分彆為(0.507 ±0.062)g/cm2、(0.461±0.095) g/cm2 (P＜0.05).高血壓、糖尿病、白內障、腦卒中、類風濕性關節炎、帕金森病除糖尿病外,其餘5種基礎疾病的伴有率兩組比較差異均有統計學意義(P＜0.05).生理領域生存質量評分初次置換組與再次置換組分彆為(76.26±14.17)分、(67.86±16.74)分(P＜0.05);現患髖對側關節Harris評分兩組分彆為(98.66±1.39)分、(90.75 ±5.39)分(P＜0.05).在治療方式選擇上,初次置換組中全髖關節置換術(total hip arthroplasty,THA)32例,單純股骨頭置換術(femoral head arthroplasty,FHA)41例,其中選用骨水泥型假體44例,生物型假體29例;再次置換組THA 2例,單純FHA 10例,選用骨水泥型假體11例,生物型假體1例(P＜0.05). 結論 跌倒仍是老年人股骨頸骨摺假體置換術後再髮健側骨摺的直接原因,增齡、女性、骨密度降低、高伴髮病、生存質量下降和初次假體置換後關節功能減退均是不利因素.假體置換仍是治療首選,術式更傾嚮于選擇骨水泥型單純FHA.
목적 탐토노년고골경골절가체치환술후재발건측고골경골절적원인급치료책략.방법 회고성분석2005년3월-2012년5월수치적고골경골절가체치환술후재발건측고골경골절,차유완정기록12례환자설위재차치환조;동기유동조의사완성적초차고골경골절행가체치환술치료적73례환자설위초차치환조,비교량조환자치상원인、년령、성별、골밀도、반발병、생존질량평분、현환관대측관절Harris평분급술식선택정황,평고재골절원인,제출치료방안. 결과 량조환자적직접치상원인균위질도;초차치환조화재차치환조비교:년령분별위(68.82 ±5.18)세、(76.83±3.64)세(P＜0.05);남녀성별구성비분별위0.66:1화0.09:1(P＜0.05);골밀도분별위(0.507 ±0.062)g/cm2、(0.461±0.095) g/cm2 (P＜0.05).고혈압、당뇨병、백내장、뇌졸중、류풍습성관절염、파금삼병제당뇨병외,기여5충기출질병적반유솔량조비교차이균유통계학의의(P＜0.05).생리영역생존질량평분초차치환조여재차치환조분별위(76.26±14.17)분、(67.86±16.74)분(P＜0.05);현환관대측관절Harris평분량조분별위(98.66±1.39)분、(90.75 ±5.39)분(P＜0.05).재치료방식선택상,초차치환조중전관관절치환술(total hip arthroplasty,THA)32례,단순고골두치환술(femoral head arthroplasty,FHA)41례,기중선용골수니형가체44례,생물형가체29례;재차치환조THA 2례,단순FHA 10례,선용골수니형가체11례,생물형가체1례(P＜0.05). 결론 질도잉시노년인고골경골절가체치환술후재발건측골절적직접원인,증령、녀성、골밀도강저、고반발병、생존질량하강화초차가체치환후관절공능감퇴균시불리인소.가체치환잉시치료수선,술식경경향우선택골수니형단순FHA.
Objective To investigate causes and treatments for a fracture of the contralateral femoral neck in the elderly with prosthetic replacement for femoral neck fractures.Methods A retrospective analysis was conducted on 85 cases undergone prosthetic replacement for femoral neck fractures between March 2005 and May 2012,including 12 cases in secondary replacement group due to fractures of the contralateral uninjured femoral neck after primary prosthetic replacement and 73 cases in primary replacement group.Variables were compared between the two groups including causes of injury,age,sex,bone density,complications,quality of life,Harris score of the contralateral hip joint,surgical choice.Refracture reasons were evaluated and treatment plans were proposed.Results Immediate cause of injury in all cases was falling.Primary and secondary replacement groups showed mean age of (68.82 ± 5.18) yearsvs (76.83 ± 3.64) years (P＜0.05),male to female ratio of 0.66:1 vs 0.09:1 (P＜0.05),and bone mineral density of (0.507 ± 0.062) g/cm2 vs (0.461 ± 0.095) g/cm2(P ＜0.05).Moreover,cases in the two groups suffered from the associated complications (hypertension,diabetes mellitus,cataract,stroke,rheumatoid arthritis,and Parkinson' s disease).Except for the diabetes mellitus,incidence of the other five basic diseases presented significance differences between the two groups (P ＜ 0.05).Of primary and secondary replacement groups,quality of life was (76.26 ±14.17) points vs (67.86 ± 16.74) points (P ＜ 0.05) ; Harris score of the contralateral hip was (98.66 ±1.39) points vs (90.75 ± 5.39) points (P ＜ O.05).For treatment choice,32 total hip arthroplasty (THA) and 41 femoral head arthroplasty (FHA) with cement fixation in 44 cases and cementless fixation in 29 cases were performed in primary replacement group; two total hip arthroplasty and 10 femoral head arthroplasty with cement fixation in 11 cases and cementless fixation in one were performed in secondary placement group (P ＜ 0.05).Conclusions Fall remains the immediate cause of the contralateral fractures following prosthetic replacement of femoral neck fractures in the elderly.Aging,females,bone density reduction,high-incidence of complications,decreased quality of life,and joint function impairment after the primary prosthetic replacement are unfavorable factors.Prosthetic replacement is still the preferred choice of treatment and surgical procedure is more likely to be the simple cemented FHA.
