CAJ | 학술논문

目的探讨生物型髋关节置换治疗股骨转子间骨折内固定术后失败的疗效.方法回顾性分析2010年2月-2014年1月治疗的17例转子间骨折固定失败患者,其中男6例,女11例;年龄41 ～ 80岁,平均67.2岁.转子间骨折15例,转子间、转子下骨折2例.初次手术内固定方式:动力髋螺钉(DHS)固定2例,股骨近端锁定板固定12例,近端防旋髓内钉(PFNA)固定3例.内固定术后3 ～48个月行关节置换,其中人工全髋置换15例,人工股骨头置换术2例.髋关节置换术前后采用Harris评分评估手术效果.术前Harris评分(32.6±6.8)分. 结果所有患者获得6～48个月随访,1例术中并发股骨骨折,加以异体骨板和钛缆固定,术后股骨柄早期下沉并脱位,再次行翻修术治愈;1例股骨柄二次下沉无疼痛,不影响活动;1例置换术后原感染复发,经多次清创、持续负压引流无效,行假体取出、扩创、临时占位器置入术,感染仍未治愈.16例术后疼痛缓解,髋关节功能恢复良好,生活自理,无假体松动发生.随访终末时Harris评分(79.2±15.9)分(P＜0.01).结论生物型人工髋关节置换术是治疗股骨转子间骨折内固定术后失败的有效方法.术后功能恢复满意,可早期负重活动,及早恢复生活自理能力,同时避免了骨水泥应用可能产生的相关并发症.
목적 탐토생물형관관절치환치료고골전자간골절내고정술후실패적료효.방법 회고성분석2010년2월-2014년1월치료적17례전자간골절고정실패환자,기중남6례,녀11례;년령41 ～ 80세,평균67.2세.전자간골절15례,전자간、전자하골절2례.초차수술내고정방식:동력관라정(DHS)고정2례,고골근단쇄정판고정12례,근단방선수내정(PFNA)고정3례.내고정술후3 ～48개월행관절치환,기중인공전관치환15례,인공고골두치환술2례.관관절치환술전후채용Harris평분평고수술효과.술전Harris평분(32.6±6.8)분. 결과 소유환자획득6～48개월수방,1례술중병발고골골절,가이이체골판화태람고정,술후고골병조기하침병탈위,재차행번수술치유;1례고골병이차하침무동통,불영향활동;1례치환술후원감염복발,경다차청창、지속부압인류무효,행가체취출、확창、림시점위기치입술,감염잉미치유.16례술후동통완해,관관절공능회복량호,생활자리,무가체송동발생.수방종말시Harris평분(79.2±15.9)분(P＜0.01).결론 생물형인공관관절치환술시치료고골전자간골절내고정술후실패적유효방법.술후공능회복만의,가조기부중활동,급조회복생활자리능력,동시피면료골수니응용가능산생적상관병발증.
Objective To observe the outcome of uncemented hip arthroplasty for failed internal fixation of intertrochanteric fracture.Methods Seventeen patients admitted from Februaty 2010 to January 2014 were reviewed retrospectively in this study.The patients aged 67.2 years (range, 41-80 years) composed 6 males and 11 females.There were 15 patients with intertrochanteric fracture and 2 intertrochanteric and subtrochanteric fracture.The primary internal fixation method was dynamic hip screw (DHS) fixation in 2 patients, proximal femoral nail anti-rotation(PFNA) fixation in 12 patients and intramedullary nailing in 3 patients.Arthroplasty with a prosthetic hip was performed for 15 patients and with a prosthetic femoral head was done for 2 patients 3-48 months after the internal fixation.Harris score was used for evaluation of the results of hip arthroplasty.Preoperative Harris score was (32.6 ± 6.8)points.Results All the patients were followed up for 6 to 48 months.One patient with intraoperative femoral fracture experienced early subsidence and dislocation of femoral stem following allogeneic bone plate and titanium cable fixation and had further revision surgery.One patient had secondary subsidence of the femoral stem without pain and limitation of motion.One patient had primary infection recurrence after arthroplasty, but the infection remained uncured even after a series of treatments like repeated debridements, sustained vacuum drainage, prosthesis removal, debridement and temporary spacer implantation.Sixteen patients showed postoperative pain relief and good hip function recovery characterized by the ability to care for themselves and no prosthetic loosening.Harris hip score signficantly improved to (79.2 ± 15.9) points at the final follow-up (P ＜ 0.01).Conclusions Uncemented hip arthroplasty is an effective method for the failed internal fixation of peritrochanteric fracture.The procedure achieves satisfactory function recovery, early weight-bearing exercise and early recovery of self-care ability,and avoids the complications of bone cement use.