CAJ | 학술논문

目的探讨人工关节置换治疗老年股骨转子间不稳定骨折的临床疗效. 方法对53例老年股骨转子间粉碎性骨折行人工关节置换术,其中全髋关节置换23例,人工双极股骨头置换30例.生物型假体50例,骨水泥型假体3例.全部为加长柄.入院距手术时间3～13 d,平均6d. 结果本组23例全髋手术时间80～ 110 min,平均90 min;术中出血量260 ～ 410 ml,平均350 ml.30例半髋手术时间50 ～ 90 min,平均65 min;术中出血量180 ～290ml,平均230ml.本组53例中51例获得随访,随访时间13～65个月,平均49.6个月.半髋置换中4例常有髋部疼痛,能忍受,口服非甾体消炎药后可缓解.1例术后发生感染,经及时清创治愈.5年内7例死于心、脑疾病,均与手术并发症无关.骨折平均愈合时间10个月.无髋臼磨损、假体松动及下沉等.髋关节功能恢复优良率为96％. 结论老年股骨转子间不稳定骨折行早期人工关节置换治疗是一种有效的方法.
목적 탐토인공관절치환치료노년고골전자간불은정골절적림상료효. 방법 대53례노년고골전자간분쇄성골절행인공관절치환술,기중전관관절치환23례,인공쌍겁고골두치환30례.생물형가체50례,골수니형가체3례.전부위가장병.입원거수술시간3～13 d,평균6d. 결과 본조23례전관수술시간80～ 110 min,평균90 min;술중출혈량260 ～ 410 ml,평균350 ml.30례반관수술시간50 ～ 90 min,평균65 min;술중출혈량180 ～290ml,평균230ml.본조53례중51례획득수방,수방시간13～65개월,평균49.6개월.반관치환중4례상유관부동통,능인수,구복비치체소염약후가완해.1례술후발생감염,경급시청창치유.5년내7례사우심、뇌질병,균여수술병발증무관.골절평균유합시간10개월.무관구마손、가체송동급하침등.관관절공능회복우량솔위96％. 결론 노년고골전자간불은정골절행조기인공관절치환치료시일충유효적방법.
Objective To investigate the effect of prosthetic replacement for senior patients with unstable intertrochanteric fractures of the femur.Methods Fifty-three senior patients with comminuted intertrochanteric fracture of the femur were subjected to total hip arthroplasty (n =23) and bipolar artificial femoral head replacement (n =30).Uncemented long-stem prostheses were used in 50 patients and cemented long-stem prostheses in 3.Time interval between admission and surgery was 3-13 days (mean 6 days).Results The total hip arthroplasty had the operation time for mean 90 minutes (range,80-110 minutes) and blood loss for mean 350 ml (range,260-410 ml).While the hemiarthroplasty had operation time for mean 65 minutes (range,50-90 minutes) and blood loss for mean 230 ml (range,180-290 ml).Fifty-one patients were available to mean 49.6-month follow-up (range,13-65 months).Four patients presented with frequent hip pain at a tolerable level after hemiarthroplasty and the symptom was relieved after oral non-steroidal anti-inflammatory drug therapy.One patient with postoperative infection was cured by timely debridement.Seven patients were died of heart and brain disorders in 5 years,with no relation to surgical complications.The period for fracture healing was mean 10 months,with excellence rate of 96％ for hip function but with no acetabulum abrasion,implant loosening or submersion.Conclusion Early prosthetic replacement is an effective treatment for unstable intertrochanteric femoral fractures in the elderly.