股骨大粗隆重建的人工关节置换治疗高龄不稳定型粗隆间骨折

Reconstruction of the femoral greater trochanter with prosthetic replacement for unstable intertrochanteric fractures in elderly patients

目的探讨重建股骨粗隆的人工关节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2009年8月至2012年1月采用股骨大粗隆骨折克氏针张力带复位固定,结合生物型股骨柄假体的人工关节置换术治疗高龄不稳定性股骨粗隆间骨折患者23例。男11例,女12例;年龄69～88岁,平均76.8岁。骨折按Evans-Jenson分型:ⅢA型7例,ⅢB型7例,Ⅳ型6例,Ⅴ型3例。手术均采用后外侧入路,利用两锥度股骨生物柄假体的顺行击入使股骨距骨折实现压迫复位与固定,并采用克氏针张力带法对大粗隆粉碎性骨折进行解剖复位与固定。术后1,3,6,12个月定期门诊随访,X线片观察假体与骨界面骨愈合情况,Harris髋关节评分评估髋关节功能。结果全部病例随访8-36个月,平均23.5个月。23例髋术后均立即实现了髋臼及股骨柄的生物性压配与初始稳定,术后3个月X线片上大粗隆骨折均获骨性愈合。术后半年Harris髋关节评分为(90.5±5.3)分,末次随访维持在(93.3±3.1)分,患者主观满意好。结论采用克氏针张力带法对大粗隆骨折进行解剖复位与固定,结合两锥度股骨生物柄假体治疗高龄不稳定型股骨粗隆间骨折可获得良好的骨折固定与似体稳定性。

Objective To investigate the operative procedures and clinical outcomes or the temoral trochanter reconstruction with prosthetic replacement for unstable intertrochanteric fractures in elderly patients. Methods From August 2009 to January 2012, 23 elderly patients with unstable femoral intertrochanteric fractures were treated by the reduction and fixation of fractures of the femoral greater trochanter with Kirschner wire tension band and biotype femoral stem prosthetic replacement, whose data were retrospectively analyzed. Among them, there were 11 males and 12 females, whose average age was 76.8 years old （range; 69-88 years）. According to the Evans- Jenson classification, there were 7 cases of type Ⅲ A, 7 cases of type Ⅲ B, 6 cases of type IV and 3 cases of type V. All surgeries were performed through posterolateral approach. With the smooth running of biotype stem prostheses of taper 2°, compression, reduction and fixation could be carried out for patients with intertrochanteric fractures. Anatomical reduction and fixation were carried out for patients with comminuted fractures of the greater trochanter using Kirschner wire tension band. Regular follow-up in the outpatient clinic was performed at 1, 3, 6, and 12 months postoperatively. The bone healing condition between the prostheses and the bone interface was observed based on the X-ray films, and the hip function was evaluated according to the Harris hip score. Results The patients were followed up for an average period of 23.5 months （range; 8-36 months）. The biotype press-fit and initial stability of the acetabulum and hip stem were immediately achieved postoperatively in 23 patients. The X-ray films showed bone healing in patients with fractures of the greater trochanter at 3 months postoperatively. The mean Harris hip score was （90.5±5.3） points at 6 months postoperatively, and maintained （933~3.1） points in the latest follow-up. All patients felt satisfied. Conclusions Kirschner wire tension band is used in the anatomical reduction and fixation of fractures of the greater trochanter, combined with the biotype stem prostheses of taper 2°, which is a good way to treat elderly patients with unstable femoral intertrochanteric fractures, with excellent fracture fixation and implant stability.