人工股骨头置换术联合爪钢板钢缆系统重建股骨大转子治疗老年不稳定股骨转子间骨折的疗效分析

Analysis of effect of Hemiarthroplasty combined with reconstruction of the greater trochanter withclaw plate and cable system in treatment of unstable intertrochanteric fractures in the elderly

目的研究人工股骨头置换术联合爪钢板钢缆系统重建股骨大转子治疗老年不稳定型股骨转子间骨折的临床疗效。方法以2015年1月-2021年8月新疆医科大学第一附属医院关节外科收治103例不稳定型股骨转子间骨折患者为研究对象,根据手术方式分为A组和B组,A组51例患者行人工股骨头置换联合爪钢板钢缆系统重建股骨大转子术,男性11列,女性40例,平均年龄(80.41±5.59)岁;B组52例患者行人工股骨头置换联合钢缆重建股骨大转子术,男性18列,女性34例,平均年龄(80.38±7.08)岁。采用髋关节视觉模拟评分(VAS)疼痛评分、髋关节Harris评分对两组患者术后1个月、3个月、6个月、1年及此后每年的髋关节疼痛、功能进行评估,采用X线片进行影像学评估。结果与B组比较,A组髋关节Harris评分在术后一年至末次随访高,髋关节VAS疼痛评分在术后一年至末次随访低,中远期结果较B组好,差异有统计学意义(P<0.05)。与B组比较,A组髋关节Harris评分末次随访时优良率较高。与B组比较,A组并发症发生率低,差异有统计学意义(P<0.05)。结论人工股骨头置换术联合爪钢板钢缆重建股骨大转子治疗老年不稳定型股骨转子间骨折疗效可靠,中远期临床疗效满意,值得临床应用推广。

Objective To investigate the clinical effect of Hemiarthroplasty combined with the reconstruction of the greater trochanter with the claw plate and cable system in the treatment of unstable intertrochanteric fractures in the elderly.Methods A total of 103 patients with unstable intertrochanteric fractures admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2015 to August 2021 were divided into group A and Group B.According to different surgical methods,In group A,51 patients underwent Hemiarthroplasty combined with the reconstruction of the femoral greater trochanter with the claw plate and cable system,including 11 males and 40 females.Mean age 80.41±5.59 years;In group B,52 patients underwent Hemiarthroplasty combined with cable reconstruction of the femoral greater trochanter,including 18 males and 34 females,with an average age of 80.38±7.08 years.Hip pain and function of the patientswere evaluated 1 month,3 months,6 months,1 year and each year after the surgery by visual analogue scale(VAS)and Harris hip score.Radiographs were used for imaging evaluation.Results Compared with group B,the hip Harris score of group A was higher from 1 year to the last follow-up after the surgery,and the hip VAS pain score was lower from 1 year to the last follow-up after the surgery,and the long-term result was better than group B,the difference was statistically significant(P<0.05).Compared with group B,group A had a higher rate of excellent hip Harris score at the last follow-up.Compared with group B,the complication rate of group A was lower,and the difference was statistically significant(P<0.05).Conclusion Hemiarthroplasty combined with claw Plate and steel cable reconstruction of the greater trochanter in the treatment of unstable intertrochanteric fractures in the elderly is effective and reliable,and the mid-long-termclinical efficacy is satisfactory,which is worthy of clinical application and Promotion.