人工股骨头置换术治疗不同的内固定物失败后的高龄股骨粗隆间骨折

Artificial femoral head replacement for treatment of the failure in different internal fixation of intertrochanteric fracture in elderly

[目的]探讨不同内固定失败后的股骨粗隆间骨折行骨水泥加长柄人工股骨头置换术的治疗效果,并比较其手术难度及治疗效果的差异。[方法]回顾性分析33例因股骨近端锁定接骨板、动力髋螺钉或髓内钉固定失败后行骨水泥加长柄人工股骨头置换术的病例资料。[结果]不同的内固定组在手术时间、术中失血量、术中输血量、总输血量、住院时间、随访期末Harris评分、并发症率、再次翻修率方面差异无统计学意义(P>0.05)。术后平均随访11.6个月,并发症发生率21.2%,再次翻修率12.1%,Harris评分优良率81.8%。[结论]骨水泥加长柄人工股骨头置换术治疗效果满意,其手术难度及治疗效果与初始内固定物的选择无关。

[Objective]To investigate curative effect of bone cement long handle artificial femoral head replacement after the failure of different internal fixation in intertrochanteric fracture. And to compare the differences of the operation difficulties and the treatment effects. [Method]A retrospective analysis was conducted on data of 33 patients treated with proximal femoral locking plate,sliding hip screw and intramedullary nail fixation of bone cement long handle artificial femoral head replacement.The differences of various indicators among three gorups were compared. [Result]The average follow-up time was 11. 6months. The different fixation groups showed no statistical differences in the operation time,intraoperative blood loss,intraoperative blood transfusion volume,the total volume of blood transfusion,time of hospitalization,Harris scores,complication rate,and the revision rate（ P 0. 05）,respectively. The complication rate was 21. 2%,the revision rate was 12. 1%,the excellent and good results rate of Harris score was 81. 8%. [Conclusion]The treatment effect is satisfactory on bone cement long handle artificial femoral head replacement. The relationship is irrelevant between the difficulty of operation,treatment effect and initial internal fixation choice.