大粗隆钢板结合髋关节置换术治疗高龄不稳定粗隆间骨折的临床观察

Clinical observation in the treatment of elderly patients unstable intertrochanteric fractures by the greater trochantrochanter reattachment divice combined with hip replacement

目的:观察应用大粗隆钢板结合人工半髋关节置换治疗高龄髋部不稳定粗隆间骨折的临床疗效。方法方法:2011年7月—2014年6月,治疗高龄不稳定股骨粗隆间骨折15例,男3例,女12例,年龄80;5岁,平均83岁。按Evans-Jensen分型,Ⅱa型8例,Ⅱb型3例,Ⅲ型4例。所有患者均行骨水泥型双动股骨头置换,同时用大粗隆钢板固定移位不稳定的股骨大粗隆。结果结果:所有患者均顺利完成手术,平均随访16个月,所有患者术后复查X线片显示移位的大粗隆骨折部位复位良好,大粗隆钢板固定牢靠,人工半髋关节假体位置满意,未出现术后下沉。根据Harris髋关节功能评分,优5例,良9例,可1例,优良率93.3%。结论结论:大粗隆钢板可有效地解决不稳定粗隆间骨折,因大粗隆移位而髋部后外侧不稳定的问题,操作简单,固定牢靠。同时高龄股骨粗隆间不稳定型骨折行人工半髋关节置换术能够满足早期负重的要求,术后并发症明显减少。

Objective:To observe the clinical effect of treatment of elderly patients unstable intertrochanteric fractures by the greater trochanter reattachment divice combined with hip replacement.Methods:From 2011 July to 2014 June,we treated 15 cases of elderly patients with unstable intertrochanteric fracture,of which 3 male and 12 female.The ages were between 80 and 95 years,the average was 83 years.According to Evans-Jensen type,8 cases of type IIA,3 cases of type IIb,4 cases of typeⅢ.All patients underwent cemented bipolar femoral head replacement,and meanwhile displaced unstable trochanteric were fixed with the greater trochanter plate.Results:All operations were successful,and the mean follow-up was 16 months.All the patients X-ray showed good site of displaced fracture of the greater trochanter,and good fixation of the greater trochanter plate,satisfactory artificial hemi hip prosthesis position without postoperative subsidence.According to the Harris score of hip joint function,excellent in 5 cases,good in 9 cases,ordinary 1 cases,the excellent and good rate was 93.3%.Conclusion:The greater trochanter plate can effectively solve the problem that the posterolateral hip become unstable because of the greater trochanter replacement in the unstable intertrochanteric fracture,and the operation is simple,stable and firm.At the same time,to the unstable intertrochanteric fracture elderly,hip joint replacement can meet the requirement of early loading and reduce the postoperative complications evidently.