目的 观察老年患者股骨转子间骨折人工股骨头置换术采用尺骨鹰嘴锁定板和钢丝捆绑固定大转子的疗效。 方法 回顾本院2018年1月至2022年12月股骨转子间骨折行人工股骨头置换患者46例，分为钢丝捆绑组（24例）和钛板固定组（22例），比较两组手术时间、出血量、初次下地时间以及术后1月、6月、12月髋关节功能VAS、Harris评分。 结果 在手术时间、出血量方面钢丝组优于钛板组，差异有统计学意义（P<0.05），患者初次下地时间，两组差异无统计学意义（P>0.05）；Harris评分：术后1月差异无统计学意义（P>0.05）；术后6月、12月钛板组优于钢丝组，差异有统计学意义（P<0.05）；VAS评分：术后1月钛板组优于钢丝组，差异有统计学意义（P<0.05），术后6月、1年差异无统计学意义（P>0.05）。 结论 与钢丝固定大转子骨折相比，钛板固定具有更好的早期关节功能。
Objective To compare the efficacy of artificial femoral head replacement for intertrochanteric fracture in elderly patients using ulnar hawksbill plate and wire binding to fix the greater trochanter. Methods Retrospective analysis of 46 patients with intertrochanteric femur fracture who underwent artificial femoral head replacement in our hospital from January 2018 to December 2022 was performed, which were divided into 24 cases in the wire binding group and 22 cases in the titanium plate fixation group. The operation time, bleeding amount, patients' first time to get down to the ground, and the difference of VAS and Harris scores of hip function at 1 month, 6 months and 12 months after operation in the two groups were compared. Results The operation time and bleeding amount in the wire group were better than those of plate group, with statistically significant differences (P<0.05). There was no statistically significant difference in the patients' first time to get down to the ground between the two groups (P>0.05). There was no statistically significant difference in Harris score of 1 month after operation (P>0.05). Harris scores of 6 months and 12 months after operation in the plate group were better than those of the wire group, with statistically significant differences (P<0.05).VAS score of 1 month after operation in the plate group was better than that of the wire group, with statistically significant difference (P<0.05). There was no statistically significant difference in the VAS score of 6 months and 1 year after surgery (P>0.05). Conclusions Compared with wire fixation of greater trochanteric fractures, plate fixation has better early joint function.
[1] Goodnough LH, Chang RN, Fasig BH, et al. Risk of revision after hip fracture fixation using DePuy synthes trochanteric fixation nail or trochanteric fixation nail advanced: a cohort study of 7,979 patients[J]. J Bone Joint Surg Am, 2022, 104(12): 1090-1097. DOI: 10.2106/JBJS.21.01029.
[2] Huang G, Zhang M, Qu Z, et al. Fixation options for reconstruction of the greater trochanter in unstable intertrochanteric fracture with arthroplasty[J]. Medicine(Baltimore), 2021, 100(26): e26395. DOI: 10.1097/MD. 0000000000026395.
[3] 陈亮, 胡定祥, 段超, 等. 改良切口抗旋髓内钉置入术治疗股骨转子间骨折[J]. 中国临床解剖学杂志, 2022, 40(3): 333-337. DOI: 10.13418/j.issn.1001-165x.2022.3.16.
Chen L, Hu DX, Duan C, et al. Intertrochanteric fractures were treated with modified incision placement of proximal femur antirotational intramedullary nail [J]. Chin J Clin Anat, 2022, 40(3): 333-337. DOI: 10.13418/j.issn.1001-165x.2022.3.16.
[4] Dubin J, Atzmon R, Feldman V, et al. Bipolar hemiarthroplasty may reduce cerebrovascular accidents and improve early weight-bearing in the elderly after femoral neck fracture[J]. Medicine (Baltimore), 2022, 101(4): e28635. DOI: 10.1097/MD.0000000000028635.
[5] Steffann F, Rubens-Duval B, Huten D. Should trochanteric fractures in elderly patients be treated by arthroplasty or internal fixation[J]? Orthop Traumatol Surg Res, 2024, 110(1S): 103778. DOI:10.1016/j.otsr.2023.103778
[6] Fink B, Ahmadian A. Outcomes of osteosynthesis of periprosthetic fractures of the greater trochanter with an anatomic claw plate[J]. J Clin Orthop Trauma, 2023, 38: 102123. DOI: 10.1016/j.jcot.2023.102123.
[7] Bhalchandra Londhe S, Churhe S, Omprakash Agrawal P, et al. Early experience with the use of trochanteric reattachment plate for the treatment of Vancouver type B 1 periprosthetic hip fractures[J]. J Clin Orthop Trauma, 2021, 23: 101644. DOI: 10.1016/j.jcot.2021.101644.
[8] Xin P, Yang J, Chen G, et al. Clinical and radiographic outcomes of long monoblock, hydroxyapatite-coated stem in revision hip arthroplasty with extended trochanteric osteotomy: a multicenter study[J]. J Orthop Surg Res, 2024, 19(1): 20. DOI: 10.1186/s13018-023-04377-1.
[9] Hersh CK, Williams RP, Trick LW, et al. Comparison of the mechanical performance of trochanteric fixation devices[J]. Clin Orthop Relat Res, 1996, (329): 317-325. DOI: 10.1097/00003086-199608000-00039.
[10]Habibi AA, Schwarzkopf R. Treatment of intraoperative trochanteric fractures during primary and revision total hip arthroplasty[J]. Orthop Clin North Am, 2024, 55(1): 19-26. DOI: 10.1016/j.ocl.2023.05.010.
京ICP备08002354号-3
