加长型骨水泥双动头假体伴钢丝捆扎治疗高龄股骨粗隆间骨折

doi:10.13418/j.issn.1001-165x.2020.05.024

中国临床解剖学杂志 ›› 2020, Vol. 38 ›› Issue (5) : 609-613. DOI: 10.13418/j.issn.1001-165x.2020.05.024

马海召¹，　冯新霞²，　付宏伟¹，　马志华¹，　韩文林¹

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Comparative study of femoral intertrochanteric fracture treated by wire bound cemented bipolar femoral head replacement and sliding hip screw internal fixation

MA Hai-zhao¹, FENG Xin-xia², FU Hong-wei¹, MA Zhi-hua¹, HAN Wen-lin¹

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摘要

目的　探究钢丝捆扎结合加长骨水泥型人工双动头置换术治疗高龄股骨粗隆间骨折的临床疗效和优势。方法　纳入80例高龄股骨粗隆间骨折患者，按照手术方式分为观察组（钢丝捆扎结合加长骨水泥型人工双动头置换术，42例）和对照组（动力髋螺钉内固定术，38例）。评估手术时间、术中与术后失血量、卧床时间、疼痛VAS评分、髋关节Harris功能情况及并发症情况。结果　观察组手术时间、术中与术后失血量高于对照组，组间比较差异有统计学意义（P<0.05）。观察组卧床时间明显较短，组间差异有统计学意义（P<0.05）。6个月及1年随访时，观察组VAS评分、Harris评分明显优于对照组，差异有统计学意义（P<0.05）。观察组并发症发生率28.6%（12例）；对照组并发症发生率63.2%（24例），差异有统计学意义（χ2=9.13，P=0.003）。结论　钢丝捆扎结合加长骨水泥型人工双动头置换术治疗高龄股骨粗隆间骨折，与动力髋螺钉内固定术比较，术中创伤大，但卧床时间短，可早期下地行功能锻炼，利于恢复正常生活，具有明显优势，值得临床推广。

Abstract

Objective　To explore the clinical effects and advantages of femoral intertrochanteric fracture treated by wire bound cemented bipolar femoral head replacement and sliding hip screw internal fixation.　Methods　 80 cases of patients with femoral intertrochanteric fracture were included in our study. All the patients were divided into the following two groups according to the surgical method: 42 cases in an experiment group and 38 cases in a control group, which were treated wire bound cemented bipolar femoral head replacement and sliding hip screw internal fixation, respectively. Some parameters such as surgical time, intraoperative blood loss, bed time, VAS score, Harris functional score and complications were evaluated. Results　The surgical time, intraoperative and postoperative blood loss of the experimental group were higher than those of the control group, there was statistical difference between the two groups (P<0.05). The bed time of the experimental group was shorter than that of the control group, there was significant difference between the two groups (P<0.05). The VAS score and Harris score of patients in the experimental group during the follow-up at 6 months and 12 months were better than those of the control group. There was statistical difference in the complication rate, the VAS score and Harris score between two groups(P＜0.05). The complication rate of the experimental group and the control group were 28.6% and 63.2% (χ2=9.13，P=0.003). Conclusions Compared with dynamic sliding hip screw internal fixation, wire bound cemented bipolar femoral head replacement has intraoperative trauma, but short bed time, thus can be carried out early functional exercises, which has better clinical effect and is worthy of clinical promotion.

导出引用

马海召, 冯新霞, 付宏伟, 马志华, 韩文林. 加长型骨水泥双动头假体伴钢丝捆扎治疗高龄股骨粗隆间骨折[J]. 中国临床解剖学杂志. 2020, 38(5): 609-613 https://doi.org/10.13418/j.issn.1001-165x.2020.05.024

MA Hai-zhao, FENG Xin-xia, FU Hong-wei, MA Zhi-hua, HAN Wen-lin. Comparative study of femoral intertrochanteric fracture treated by wire bound cemented bipolar femoral head replacement and sliding hip screw internal fixation[J]. Chinese Journal of Clinical Anatomy. 2020, 38(5): 609-613 https://doi.org/10.13418/j.issn.1001-165x.2020.05.024

中图分类号： R683.42

参考文献

[1] Altun G, Saka G, Demir T, et al. Precontoured buttress plate vs reconstruction plate for acetabulum posterior wall fractures: a biomechanical study[J]. World J Orthop, 2019, 10(5): 219-227.
[2] Correa-Valderrama A, Stangl-Herrera W, Echeverry-Vélez A, et al. Relationship between body mass index and complications during the first 45 days after primary total hip and knee replacement: a single-center study from south america[J]. Clin Orthop Surg, 2019, 11(2): 159-163.
[3] 王武, 翟生, 韩小平, 等. 股骨近端抗旋髓内钉与动力髋螺钉对老年不稳定股骨粗隆间骨折疗效的对比研究[J]. 中华医学杂志, 2018, 98(5): 357-361.
[4] 龙行春, 曹毅, 周振宇, 等. 人工股骨头置换与防旋型股骨近端髓内钉内固定治疗高龄不稳定型股骨粗隆间骨折的临床疗效[J]. 中国老年学杂志, 2017, 37(21): 5377-5379.
[5] El-Husseiny M, Masri B, Duncan C, et al. Long-term results of tripolar constrained total hip arthroplasty in revision hip arthroplasty: a minimum follow-up of ten years[J]. Bone Joint J, 2019, 101-B (6 Supple B): 123-126.
[6] Gurger M. Factors impacting 1-year mortality after hip fractures in elderly patients: a retrospective clinical study[J]. Niger J Clin Pract, 2019, 22(5): 648-651.
[7] Lee YK, Won HJ, Roa KRU, et al. Bipolar hemiarthroplasty using microarc oxidation-coated cementless stem in patients with unstable intertrochanteric fracture[J]. J Orthop Surg (Hong Kong), 2019, 27(2): 2309499019847815.
[8] Min BW, Lee KJ, Oh JK, et al. The treatment strategies for failed fixation of intertrochanteric fractures[J]. Injury, 2019, 50(7): 1339-1346.
[9] 杨家赵,孙建皖,王叙进, 等.骨水泥型双动头置换治疗高龄股骨转子间骨折的临床疗效[J].临床骨科杂志,2017,20(6):707-709. DOI:10.3969/j.issn.1008-0287.2017.06.024.
[10] 袁伟, 程少文, 彭磊. PFNA-Ⅱ、LCP及股骨头置换三种方法治疗A2型股骨粗隆间骨折的比较[J]. 中国矫形外科杂志, 2018, 26(12): 1090-1093.
[11] 蔡保塔, 徐成毅, 曹军, 等. 三种内固定方式治疗老年股骨转子间骨折的疗效比较[J]. 中华创伤骨科杂志, 2016, 18(7): 564-568.
[12] 赵恒伍, 张磊, 廉明, 等. 改良动力髋螺钉治疗老年股骨转子间骨折 (A2型) 的疗效[J]. 中国老年学杂志, 2018, 38(3): 614-616.