[1]李梦远,陈宏　马元琛,廖俊星,等.老年髋部骨折内固定失败后补救性髋关节置换术的临床研究[J].中华老年骨科与康复电子杂志,2016,(02):81-86.[doi:10.3877/cma.j.issn.2096-0263.2016.02.004]
　Li Mengyuan,Chen Hong,Ma Yuanchen,et al.Clinical research of hip arthroplasty as a salvage treatment after reduction and fixation failure in the proximal femoral fracture[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(02):81-86.[doi:10.3877/cma.j.issn.2096-0263.2016.02.004]
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老年髋部骨折内固定失败后补救性髋关节置换术的临床研究()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2016年02期
页码:
81-86
栏目:
髋部骨折
出版日期:
2016-05-17

文章信息/Info

Title:
Clinical research of hip arthroplasty as a salvage treatment after reduction and fixation failure in the proximal femoral fracture
作者:
李梦远; 陈宏　马元琛; 廖俊星; 王子南; 郑秋坚
510080 广州，广东省人民医院（广东省医学科学院）骨科
Author(s):
Li Mengyuan;  Chen Hong;  Ma Yuanchen;  Liao Junxing;  Wang Zinan;  Zheng Qiujian.
Department of Orthopaedic, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou 510080, China
关键词:
关节成形术; 置换; 髋; 　髋骨折; 　骨折固定术; 内; 　治疗失败
Keywords:
Arthroplasty;  replacement;  hip; 　Hip fractures; 　Fracture fixation;  internal;  　 Treatment failure
DOI:
10.3877/cma.j.issn.2096-0263.2016.02.004
摘要:
目的　探讨老年髋部骨折内固定失败后人工髋关节置换术的治疗效果及手术技巧。方法　回顾性分析2009 年6 月至2014 年11 月，广东省人民医院采用人工髋关节置换术治疗股骨颈骨折或股骨转子间骨折复位内固定失败的患者23 例，男性14 例（61%），女性9 例（39%）；其中股骨颈骨折内固定失败19 例，转子间骨折内固定失败4 例；年龄60 ～ 87 岁，平均（72±10）岁；髋关节置换术与内固定手术之间相隔4 ～ 252 个月，平均（59±37）个月。随访并比较患者手术前后股骨颈干角、双下肢长度差值及Harris 评分变化。结果　20 例（95.2%）患者获得满意随访，随访时间10 ～ 60 个月，平均随访（29±20）个月。手术时间为72 ～ 125 min，平均（86±32）min；术中出血量为320 ～ 860 ml，平均（486±147）ml。术中未发生血管及神经牵拉损伤。术后假体脱位1 例，复位后功能恢复良好。末次随访所有患者假体均未出现松动、下沉。与术前相比，股骨颈骨折患者的颈干角明显增多（t=6.263，P ＜ 0.01），肢体长度差显著降低（t=3.516，P ＜ 0.01）；股骨转子间骨折患者的肢体长度差显著降低（t=3.576，P ＜ 0.05），差异均有统计学意义。Harris 评分由术前（36.9±3.2）分提高至术后（87.2±6.5）分，优良率85%，差异具有统计学意义（t=49.248， P ＜ 0.01）。结论　髋部骨折内固定术后，人工髋关节置换术作为补救治疗，能够减少肢体长度差，恢复颈干角，改善关节功能，且并发症少。
Abstract:
Objective　To evaluate clinical effects and influence factors of total hip arthroplasty as a salvage treatment after reduction and fixation failure of hip fractures in the elderly. Methods　Between June 2009 and November 2014, 23 hip fractures with failed internal fixation were treated with hip arthroplasty, including 14 males (61%) and 9 females (39%) with an average age of (72±10) years old (60-87 years). There were 19 internal fixation failure of femoral neck fractures and and 4 failure of femoral intertrochanteric fractures. The average interval time between internal fixation and hip arthroplasty was (59 ±37) months (4-252 months). All patients were well followed up and comparison of clinical effects, the length difference of bilateral lower limb and the neck-shaft angle were done before and after surgery. Results　20 (95.2%) patients were followed up 10 to 60 months, with an average of (29±20) months. The mean duration of hip arthroplasty was (86±32) minutes (72-125 minutes) and the mean blood loss was (486±147) ml (320-860 ml). There was no nerve injury and vascular avulsion injury. One prosthesis dislocation occurred after surgery, and after reduction, the patient got a good recovery. No prosthetic loosening or subsidence were observed at the end of follow-up. After surgery, for the patients of femoral neck fractures, the neck-shaft angle was significantly increased (t=6.263, P<0.01) and the length difference of bilateral lower limb was significantly reduced (t=3.516, P<0.01), for the patients of intertrochanteric fractures, the length difference of bilateral lower limb was significantly reduced (t=3.576, P<0.05). Harris scores of all patients were (36.9±3.2) pre-operatively and (87.2±6.5) post-operatively, the difference was statistically significant (t=49.248, P<0.01), and the excellent rate was 85%. Conclusions　Hip arthroplasty can reduce the length difference of bilateral lower limb, restore the neck-shaft angle, improve the joint function with limited complications. It is an effective salvage treatment for internal fixation failure of hip fractures.

参考文献/References:

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备注/Memo

备注/Memo:
国家自然科学基金（81371991）
更新日期/Last Update: 2016-05-17