人工股骨头置换联合大粗隆再结合装置治疗老年股骨粗隆间骨折

HEMIARTHROPLASTY COMBINED WITH GREATER TROCHANTER REATTACHMENT DEVICE FOR TREATING INTERTROCHANTERIC FRACTURES IN ELDERLY PATIENTS

目的探讨采用人工股骨头置换联合大粗隆再结合装置治疗老年股骨粗隆间骨折的临床疗效。方法回顾分析2010年2月一2013年4月采用人工股骨头置换联合大粗隆再结合装置治疗的34例（35髋）老年股骨粗隆间骨折患者临床资料。其中男16例（16髋），女18例（19髋）；年龄77～95岁，平均85．6岁。均为摔伤所致。左髋20例，右髋13例；双髋l例。新鲜骨折33例（34髋），陈旧性骨折1例（1髋）。骨折按Evans．Jensen分型：III型6例（6髋），IV型1l例（11髋），V型17例（18髋）。患者均存在不同程度骨质疏松，合并内科疾病。结果患者均顺利完成手术。手术时间70～90rain，平均76．6min：术中出血量260～400mL，平均301．5mL；术后引流量80～530mL，平均290．6mL；住院时间10～12d，平均11．7d。术后1例出现切口感染，经换药后治愈；其余切口均I期愈合，无下肢深静脉血栓形成等并发症发生。26例（27髋）获随访，随访时间12～48个月，平均21_3个月。x线片检查示股骨粗隆间骨折均愈合，愈合时间2．5～3．5个月，平均2．8个月；随访期间均无假体松动、下沉、脱位，无钛缆松动及周围骨溶解等并发症发生。术后1年髋关节Harris评分，获优8髋，良15髋，可4髋，优良率85．2％。结论人工股骨头置换联合大粗隆再结合装置治疗老年股骨粗隆间骨折可行、有效，患者可早期下地活动，提高了生活质量，但需严格把握适应证以及围手术期管理。

Objective To evaluate the effectiveness of hemiarthroplasty combined with greater trochanter reattachment device for intertrochanteric fractures in elderly patients. Methods A retrospective analysis was made on the clinical data of 34 patients （35 hips） with intertrochanteric fractures underwent hemiarthroplasty combined with greater trochanter reattachment device between February 2010 and April 2013. Of 34 patients, 16 were males （16 hips） and 18 were females （19 hips）, and the mean age was 85.6 years （range, 77-95 years）. All fractures were caused by falling. The left hip was involved in 20 cases, the right hip in 13 cases, and the bilateral hips in 1 case. There were 33 cases （34 hips） of fresh fracture, and 1 case （1 hip） of old fracture. Fractures were rated as type III in 6 cases （6 hips）, type IV in 11 cases （11 hips）, and type V in 17 cases （18 hips） according to Evans-Jensen standard. All of the patients had different degree of osteoporosis and internal diseases. Results All patients underwent surgery successfully. The operation time was 70-90 minutes （mean, 76.6 minutes）; the intraoperative blood loss was 260-400 mL （mean, 301.5 mL）; the postoperative drainage was 80-530 mL （mean, 290.6 mL）; and the hospitalization time was 10- 12 days （mean, 11.7 days）. Postoperative infection of incision occurred in 1 case, which was cured after dressing; primary healing of incision was obtained in the other patients. No lower extremity deep vein thrombosis or other complications was observed. Twenty-six cases （27 hips） were followed up 12-48 months （mean, 21.3 months）. X-ray examination showed fracture healing, and the healing time was 2.5-3.5 months （mean, 2.8 months）. There was no dislocation, prosthesis loosening, dislocation, loosening of titanium cable, periprosthetic osteolysis, or other complications during the follow-up period. According to Harris hip score, the results were excellent in 8 hips, good in 15 hips, fair in 4 hips, and the excellent and good rate was 85.2% at 1 year after operation. Conclusion The hemiarthroplasty combined with greater trochanter reattachment device is a feasible and effective method to treat intertrochanteric fractures in the elderly patients. It can allow early ambulation and improve quality of life, but it is necessary to strictly control the indications, and perioperative management should be paid attention.