全髋关节置换治疗股骨转子间骨折37例

Total hip replacements for intertrochanteric fracture after internal fixation failure in 37 patients

选择2000-07/2008-03郴州市第一人民医院骨科收治的股骨转子间骨折内固定失败患者37例,男20例,女17例,年龄63～84岁,平均74岁。均由于内固定后并发镙钉对股骨头、颈和髋臼的切割破坏而再次行全髋关节置换。距第1次内固定的时间为13～23个月。全部病例无严重心肺功能不全、局部感染等置换禁忌证,置换前Harris评分为(40.0±12.2)分。37例患者采用骨水泥型假体置换18例,采用非骨水泥型假体置换19例。本组37例患者均获得随访,平均6.3个月。全部病例平均置换时间(81.0±13.6)min,置换过程出血量(662.0±51.8)mL。置换后无伤口感染、脱位、坠积性肺炎、压疮、下肢深静脉栓塞等并发症。随访期间未出现髋部疼痛、无力、活动受限等异常,X射线平片未见假体松动、下沉、脱位,骨质疏松情况逐步改善。置换后Harris评分为(83.0±12.4)分,其中优20例,良12例,可4例,差1例,优良率86.49%。提示假体置换是治疗转子间骨折内固定失败后的一种有较治疗方法。

PThirty-seven patients suffering from internal fixation failure in treating intertrochanteric fracture were selected from Department of Orthopaedics, First People＇s Hospital of Chenzhou between July 2000 and March 2008, including 20 males and 17 females aged 74 years （range 63 84 years）. All were treated by total hip replacement （THR） due to cutting damage of screws to femoral head, neck and acetabulum. The THR was performed 13 23 months from the first internal fixation. All patients had no severe cardiorespiratory dysfunction, local infection or other contraindication for replacement. Preoperative Harris scores were （40.0±12.2） points. Among all patients, 18 were treated by cemented THR, and the others by un-cemented. All 37 patients were followed up for average of 6.3 months. The average operative time was （81±13.6） minutes; the average amount of bleeding in operation was （662±51.8） mL. No infection, hypostatic pneumonia, pressing sore or deep venous embolism of lower limbs was found after replacement. Hip pain, weakness, limitation of motion did not occur during the follew-up period. In addition, no loosening or breaking of prosthesis was found on X-ray films, but the esteoporosis was gradually improved. The Harris scores were （83.0~12.4） postoperatively. The outcomes were excellent in 20 cases, good in 12 cases, fair in 4 cases, and poor in 1 case, and the rate of excellent and good was 86.49%. THR is an effective method for intertrochanteric fracture after internal fixation failure.