股骨转子间骨折人工关节置换术中转子部骨折固定技术的应用

Surgical techniques for the fixation of trochanteric fracture compartments in hip arthroplasty for femoral intertrochanteric fractures

目的探讨股骨转子间骨折人工关节置换术中转子部骨折固定的理想方式及选择依据。方法采用人工关节置换术治疗86例老年股骨转子间骨折患者。骨折按照Evans-Jenson分型,Ⅱ型2例,Ⅲ型22例,Ⅳ型45例,Ⅴ型17例。双极人工股骨头置换50例,全髋关节置换术36例。转子部骨折块采用金属线缆＂双交叉法＂捆绑固定46例,采用连接钛缆GTR接骨板固定技术28例,其他方法 12例。结果手术成功78例,术后发生转子部骨折移位5例（合并假体柄松动下沉2例）,关节脱位1例,假体深部感染1例,中毒性肠麻痹死亡1例。住院期间发生坠积性肺炎2例,无坐骨神经损伤和严重的血栓栓塞并发症发生。2例出院后失访,76例均获随访,时间3~79个月。1例于术后2年死于急性心肌梗死,1例术后5个月死于脑溢血。末次随访时根据Harris髋关节功能判定标准,优52例,良13例,中9例,优良率为87.8%。转子部骨折愈合时间3~8个月。结论老年人股骨转子间骨折采用人工关节置换治疗中,转子部骨折块的可靠固定对于术后开始进行康复训练的时间、行走步态和假体的使用寿命具有重要影响。

Objective To explore the ideal fixation techniques and selection criteria for trochanteric fracture fragments when treating intertrochanteric fractures of the femur by hip arthroplasty. Methods 86 cases of femoral intertrochanteric fractures were undergone hip arthroplasties. According to Evans-Jenson classification,there were 2 cases with type Ⅱ fractures,22 with type Ⅲ,45 with type Ⅳ and 17 with type Ⅴ. 50 cases were received bipolar hemi-arthroplasty and 36 cases were received total hip arthroplasty. Double cross binding fixation techniques with metal wires or cables were employed in 46 cases,cable-ready greater trochanteric reattachment fixation techniques in 28 cases,and other methods in 12 cases in treating femoral trochanteric fracture fragments. Results 78 cases got succeed in their operations with fracture displacement postoperatively in 5 cases（ combined with loosening and sinking of femoral stem in 2 cases）,dislocation in 1 case,deep periprosthetic infection in 1 case and dying of toxic ileus in 1 case. 2 cases got hypostatic pneumonia during hospitalization. No sciatic nerve injury and severe thromboembolic complications were found. 76 cases were followed up from 3 to 79 months except 2 cases lost after discharge,1 case died of acute myocardial infarction one year after operation and 1 case died of a brain hemorrhage in five months after operation.According to the Harris score of hip joint,the result at final follow-up was excellent in 52 patients,good in 13 and fair in 9,with excellent-good rate of 87. 8%. Inter trochanteric fracture healing time was 3 to 8 months. Conclusions Reliable fixation of trochanteric fracture fragments in hip arthroplasty treated for the femoral intertrochanteric fractures in the eldly has an important influence on deciding the time to start postoperative rehabilitation,walking gait and durability of prostheses.