人工关节置换治疗老年股骨转子间骨折的优势与不足

Arthroplasty for treating intertrochanteric femur fractures in older adults: advantages and disadvantages

背景:由于社会步入老龄化,老年股骨转子间骨折发病率亦呈现上升趋势,其治疗方法也多种多样。积极手术治疗、早期下地活动、减少术后并发症是目前基本的治疗原则,手术方法包括内固定和人工关节置换两大类,人工关节置换目前仅用于严重粉碎性骨折伴严重骨质疏松的患者。近年来国内外开始尝试人工关节置换治疗老年股骨转子间骨折,但疗效与安全性仍存在诸多争议。人工关节置换作为其中的一种治疗方法,随着它的优势越来越明显,逐渐受到临床骨科医师的关注。目的:通过对国内外人工关节置换治疗老年股骨转子间骨折的体会进行综述,为骨科医师在临床治疗老年股骨转子间骨折提供选择。方法:第一作者应用计算机检索2000年1月至2018年10月PubMed数据库、Webofscience数据库、万方数据库、中国期刊全文数据库的相关文章,英文检索词"intertrochanteric fractures of the femur,the elderly,artificial joint replacement,fracture treatment";中文检索词"股骨转子间骨折,老年人,人工关节置换,骨折治疗"。结果与结论:①共检索到75篇相关文献,60篇文献符合纳入标准;②人工髋关节置换治疗老年股骨转子间骨折短期疗效令人满意,但是术前必须明确人工置换的适应证及禁忌证;③国内外文献在老年股骨转子间骨折治疗手段上并未达成一致,目前开展的临床治疗较少,缺少多中心大样本量的临床试验,这些都需要进一步研究探索。

BACKGROUND: Due to the aging of society, the incidence of intertrochanteric fractures in the elderly has increased, and its treatment methods are diverse. Active surgical treatment, early-term ground movements, and reduction of postoperative complications are the basic principles of the treatment. The surgical methods include internal fixation and arthroplasty. Arthroplasty is only used in severe comminuted fracture with severe osteoporosis. In recent years, arthroplasty has been applied for treating intertrochanteric femur fractures in the elderly at abroad and home, but there are still controversies about the efficacy and safety. As one of the treatment methods, arthroplasty has gradually attracted the attention of clinical orthopedic surgeons as its prominent advantages. OBJECTIVE: To review the experience of arthroplasty at home and abroad in the surgical treatment of intertrochanteric femur fractures in the elderly, so as to provide an option for orthopedic surgeons in the treatment of intertrochanteric fractures in the elderly. METHODS: A computer-based retrieval of PubMed, Web of science, WanFang, and CNKI databases for the articles published from January 2000 to October 2018. The keywords were “intertrochanteric fractures of the femur, the elderly, artificial joint replacement, fracture treatment” in English and Chinese, respectively. RESULTS AND CONCLUSION:(1) Seventy-five articles were retrieved, and 60 eligible articles were included.(2) Hip arthroplasty exhibits a satisfactory short-term efficacy in the treatment of intertrochanteric femur fractures in the elderly. However, indications and contraindications for arthroplasty must be clarified before surgery.(3) Domestic and foreign literatures have not reached agreement on the treatment of intertrochanteric femur fractures in the elderly. The related clinical trials are few and there is a lack of multi-center large-sample clinical trials, which require to be investigated in depth.