摘要
背景:高龄老年人股骨转子间骨折行半髋关节置换,选择标准柄股骨假体还是加长柄股骨假体,一直困扰临床医生。目的:对比标准柄与加长柄体假体置换治疗高龄粉碎性转子间JensenⅤ型骨折的短期临床疗效。方法:回顾分析娄底市中心医院2008年1月至2019年1月收治的216例高龄粉碎性股骨转子间JensenⅤ型骨折患者,行骨水泥型人工半髋关节置换。根据股骨柄假体长度分为2组,标准柄组92例,加长柄组124例。依据骨折情况,采取钢丝克氏针复位大小转子骨折。术后1年评估髋关节Hariss评分,通过X射线片观察假体周围影像学表现。结果与结论:①标准柄组术后死亡2例,加长柄组术后死亡3例,其余均获随访,随访时间12-24个月;②术后1年标准柄组的Harris评分为(88.6±2.9)分,疗效优良率为83.3%;术后1年加长柄组的Harris评分为(86.9±2.7)分,疗效优良率为82.6%,2组相比差异无显著性意义(P>0.05);③标准柄组中1例股骨大转子骨折不愈合,2例股骨小转子骨折不愈合,2例发生Brooker 1级异位骨化;加长柄组中1例股骨大转子骨折不愈合,3例股骨小转子骨折不愈合,2例发生Brooker 1级异位骨化,2组并发症发生率差异无显著性意义(P>0.05);④提示标准柄与加长柄骨水泥型假体置换治疗高龄转子间JensenⅤ型骨折的近期疗效均满意,且无明显差异,但远期效果有待进一步研究。
BACKGROUND:The choice of standard femoral prosthesis or lengthened femoral prosthesis for the treatment of femoral intertrochanteric fracture in the elderly with hemihip replacement has always troubled clinicians.OBJECTIVE:To compare the short-term clinical efficacy of standard and long-stem prosthesis replacement in the treatment of elderly comminuted intertrochanteric Jensen V fractures.METHODS:Data of 216 elderly patients with comminuted intertrochanteric femoral Jensen V fractures undergoing bone cement artificial half hip arthroplasty in Loudi Central Hospital from January 2008 to January 2019 were retrospectively analyzed.According to the type of prosthesis,the patients were divided into standard stem prosthesis placement group(n=92)and long-stem prosthesis replacement group(n=124).According to the fracture situation,the wire Kirschner wire was used to reduce the trochanteric fracture.At 1 year after surgery,Hariss score of the hip joint was evaluated.X-ray examination was used to observe imaging manifestations around the prosthesis.RESULTS AND CONCLUSION:(1)Two patients in the standard stem prosthesis placement group died;three patients in the long-stem prosthesis replacement group died.The remaining patients were followed up for 12-24 months.(2)At 1 year after surgery,Hariss scores were(88.6±2.9)in the standard stem prosthesis placement group with an excellent and good rate of 83.3%,and(86.9±2.7)in the long-stem prosthesis replacement group with an excellent and good rate of 82.6%;no significant difference was found between the two groups(P>0.05).(3)In the standard stem prosthesis placement group,one case affected femoral greater trochanteric fracture nonunion;two cases had femoral small trochanteric fracture nonunion;two cases experienced Brooker’s grade 1 heterotopic ossification.In the long-stem prosthesis replacement group,one case affected femoral greater trochanteric fracture nonunion;three cases had femoral small trochanteric fracture nonunion;two cases experienced Brooker’s grade 1 heterotopic ossification.There was no significant difference in the incidence of complications between the two groups(P>0.05).(4)It is indicated that the short-term clinical efficacy of standard and long-stem cement-type prosthesis replacement in the treatment of Jensen V type trochanteric fracture in elderly patients is satisfactory,with no statistical difference,but the long-term effect remains to be studied.
作者
成世高
王万春
蒋栋
李腾飞
李洵
任炼
Cheng Shigao;Wang Wanchun;Jiang Dong;Li Tengfei;Li Xun;Ren Lian(The Second Xiangya Hospital of Central South University,Changsha 410011,Hunan Province,China;Loudi Central Hospital,Loudi 417000,Hunan Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2021年第3期362-367,共6页
Chinese Journal of Tissue Engineering Research
基金
2017年湖南省临床医疗技术创新引导计划项目(2017SK51203),项目负责人:成世高~~。
关键词
骨
股骨
转子间骨折
老年
关节
置换
骨水泥型
假体
骨折愈合
bone
femur
intertrochanteric fracture
old age
joint
replacement
cement type
prosthesis
fracture healing