重建股骨距人工股骨头置换术治疗高龄股骨粗隆间骨折

TREATMENT OF UNSTABLE FEMORAL INTERTROCHANTERIC FRACTURE IN ELDERLY PATIENTS WITH REBUILD SEPTUM BRONCHIALE IN ARTIFICIAL FEMORAL HEAD REPLACEMENT

目的探讨重建股骨距结合人工股骨头置换治疗高龄不稳定性股骨粗隆间骨折的手术方法及疗效。方法回顾分析2005年10月-2007年10月收治的113例高龄不稳定性股骨粗隆间骨折患者,采用复位固定股骨大、小粗隆,修复稳定股骨近端,重建股骨距结合骨水泥型人工股骨头置换术治疗58例(修复组);采用切开复位γ钉内固定术治疗55例(对照组)。修复组:男21例,女37例;平均年龄75岁。骨折按Evans-Jenson分型:ⅢA型10例,ⅢB型16例,Ⅳ型32例。对照组:男17例,女38例;平均年龄72.5岁。骨折按Evans-Jenson分型:ⅢA型13例,ⅢB型14例,Ⅳ型28例。两组均为摔伤,受伤至手术时间为3h～7.5d,平均1.4d。两组均合并骨质疏松,合并冠心病、高血压病、糖尿病、慢性支气管炎等慢性疾病的1种或几种;无其他部位骨折。两组一般资料比较差异无统计学意义(P>0.05)。结果两组患者均顺利完成手术,修复组手术时间、术中出血量、输血量均明显少于对照组(P<0.05)。术后两组切口均Ⅰ期愈合。两组患者均获随访,随访时间12～36个月。术后12个月修复组并发症发生率为3.4%,对照组为16.4%,比较差异有统计学意义(P<0.05);按照Harris标准评定髋关节功能,修复组优良率93.1%,对照组70.9%,差异有统计学意义(P<0.05)。结论人工股骨头置换治疗高龄股骨粗隆间骨折的临床效果良好,稳定近端、重建及修复股骨距是手术关键。

Objective To investigate the operative procedure and the therapeutic effects of unstable femoral intertrochanteric fracture in elderly patients with rebuild septum bronchiale in artificial femoral head replacement. Methods From October 2005 to October 2007, 113 elderly patients with unstable femoral intertrochanteric fracture were treated with artificial femoral head replacement with fixation of femoral greater trochanter and smaller trochanter in the help of bone cement in 58 cases （test group） and with 7-type bone nail in 55 cases （control group）. In test group, there were 21 males and 37 females with an average age of 75 years, including 10 cases of type ⅢA, 16 cases of type ⅢB and 32 cases of type Ⅳ according to Evans-Jenson standard. In control group, there were 17 males and 38 females with an average age of 72.5 years, including 13 cases of type ⅢA, 14 cases of type ⅢB and 28 cases of type Ⅳ according to Evans-Jenson standard. All fractures were caused by fall damage. The disease course was 3 hours to 7.5 days （mean 1.4 days）. The patients of two group complicated with osteoporosis, and complicated by one or several complications of coronary heart disease, hypertension, diabetes and chronic bronchitis. And all patients did not had fracture at other sites. There was no significant difference in general data between two groups （P 〉 0.05）. Results The operations were successful, the incision healed by first intention. There were significant differences in operation time, operative blood loss and blood-transfusion between two groups （P 〈 0.05）. The two group were followed 12-36 months. There were significant differences （P 〈 0.05） in the incidence rate of compl ication and the excellent and good rate of hip function （by Harris standard） between the test group （3.4% and 93.1%） and the control group （16.4% and 70.9%） 12 months after operation. Conclusion The aged patients with intertrochanteric fracture can get good result through caput femoris replacement, and rebuild septum bronchiale is of great significance.