空心螺钉捆绑带结合半髋关节置换治疗高龄粗隆间骨折的近期疗效

Short-term efficacy of hollow screw bandage combined with hemiarthroplasty for elderly intertrochanteric fractures

目的探讨空心螺钉捆绑带结合半髋关节置换治疗高龄股骨转子间骨折的近期疗效.方法回顾性分析2015年8月至2017年8月新疆自治区人民医院收治的采用后外侧手术入路,股骨双动头置换结合空心螺钉及捆绑带重建股骨大粗隆的方法,治疗股骨粗隆间骨折尤其是股骨外侧壁破坏较为严重的高龄患者.术后第1天、第1、3、6个月及1年复查C反应蛋白、红细胞沉降率、血常规以及X线片,观察术后X线片是否达到骨性愈合,捆绑带及空心螺钉是否松动,股骨柄假体有无松动及下沉,使用Harris髋关节评分(HHS)评价患者髋关节功能,利用直立行走试验(TUG)评估关节活动.结果15例患者术后1年的X线片均可见大转子骨折实现了骨性愈合,空心螺钉及捆绑带未见松动,骨水泥长柄稳定,未见明显松动及下沉,C反应蛋白、红细胞沉降率、血常规均正常,伤口局部无红肿,无感染征象.Harris评分:末次随访的HHS评分为(76±17)分.末次随访TUG为(17±9)s.术后2例患者出现大粗隆外侧活动后出现轻度疼痛,休息可缓解.末次随访,臀中肌外展肌力达到5级的共5例,4级共4例,3级的共3例.残留轻度跛行的3例,均为臀中肌外展肌力3级(2例)者.1例对手术疗效较不满意,跛行(1例),其余14例表示非常满意或比较满意.所有患者均于术后3 d内下地行走.结论采用股骨双动头置换,结合空心螺钉及捆绑带重建股骨大粗隆的方法,治疗高龄股骨转子间骨折,可获得早期初始稳定性,帮助患者早日下床活动,近期疗效较好,显著提高了患者的生活质量.

Objective The main purpose of this study is to investigate the short-term effect of hollow screw banding combined with hemiarthroplasty in the treatment of intertrochanteric fracture in the elderly.Methods From August 1,2015 to August 1,2017,patients with intertrochanteric fracture of femur in the People's Hospital of Xinjiang Autonomous Region were selected,especially those with serious destruction of the lateral wall of femur.All operations were performed through the posterolateral approach.Double-acting femoral head replacement combined with hollow snail were used during the operation.C-reactive protein,erythrocyte sedimentation rate,blood routine and X-ray films were reviewed on the first day,1,3,6 months and 1 year after operation.Bone healing,loosening of bandage and hollow screw,loosening and subsidence of femoral stem prosthesis were observed on X-ray films.The hip function was evaluated by Harris hip score(HHS),Assessment of joint activity(TUG).Results One year after operation,15 cases of trochanteric fracture showed bone healing,no loosening of hollow screw and binding band,stable long handle of bone cement,no obvious loosening and sinking,normal C-reactive protein,erythrocyte sedimentation rate and blood routine,no redness and swelling in wound area,no signs of infection.Harris score:The HS score at the last follow-up was(76+17).The TUG score at the last follow-up was(17+9)seconds.Mild pain occurred after lateral movement of greater trochanter after operation,and 2 cases could be relieved by rest.At the last follow-up,the abductor strength of gluteus medius reached grade 5 in 5 cases,grade 4 in 4 cases,and grade 3 in 3 cases.There were 3 cases of residual mild lameness,all of which were grade 3(2 cases)of gluteal abductor strength.One case was unsatisfied with the effect of operation,limping(1 case),and the other 14 cases were very satisfied or satisfied.All patients walked within 3 days after operation.Conclusion The treatment of intertrochanteric fracture of femur in elderly patients with femoral head replacement combined with hollow screw and bandage reconstruction can obtain early initial stability,help patients get out of bed early,and have a good short-term effect,which significantly improves the quality of life of patients.