髋关节置换术后大转子骨折的治疗

Treatment of greater trochanter fracture after total hip replacement

目的研究髋关节置换（THR）术后大转子骨折的治疗效果。方法回顾性分析2004至2009年收治的11例THR术后大转子骨折患者，男3例，女8例；年龄52～79岁，平均69岁。发现大转子骨折距THR术后2d～95个月。2例术后第2天发现，3例术后7个月内常规复诊发现，6例有明确外伤史，5例发生于术后2年以上。骨折移位距离平均12mm（3～38mm）。10例保守治疗，自发现骨折起，患髋部分负重6～12周，避免主动性外展。1例切开复位缝合。所有患者定期随访，了解患髋疼痛、活动功能；观察步态，Trendlenburg征；摄患髋正侧位片，测量骨折移位距离，评价骨折愈合。结果所有患者均获随访12～68个月，平均40个月。末次随访时患髋关节均无疼痛，活动正常。10例保守治疗者1年随访时步态正常，Trendlenburg征阴性，末次随访骨折移位距离均未见增加。5例呈骨性愈合，6例为纤维愈合。结论THR术后大转子骨折通常较为稳定，采用保守治疗可获较好疗效。

Objective To explore the treatment of greater trochanter fracture after total hip replacement （THR）. Methods This series consisted of 3 males and 8 females with fractures of greater trochanter after total or partial hip replacement from 2004 to 2009. The mean age at the time of fracture diagnosis was 69 years old （range：52 -79）. Two fractures were seen on radiograph at Day 2 postoperation and 3 found during a regular follow-up within the first 7 months after primary THR. They had no symptoms. Six patients fell and five of them occurred over 2 years after THR. The average migration between trochanter and proximal femur were 12 mm （range ：3 -38 ）. Ten cases underwent protected weight bearing for 6 - 12 weeks and avoidance of active abduction until union was complete or there was no pain. Only one case suffered hip dislocation with a 38-ram migration and underwent operative repair of greater trochanter with suture. Hip pain, instability, range of motion and Trendlenburg gait were examined during a regular follow- up. Evaluations of fracture migration and bone healing were performed from the radiograph of AP and lateral views of hip. Results There was no patient loss. The mean follow-up period was 40 months （range ： 12 - 68 ）. All had nearly normal function and no symptoms at the latest follow-up. For 10 non-operatively treated cases, the fractures remained non-displaced and the Trendlenburg sign was negative at the final visit. Bone healing occurred in 5 patients. Fibrous union occurred in another 6 patients. Conclusion The post-THR fractures of greater trochanter are usually stable and may be treated non-operatively.