中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (17): 3210-3212.doi: 10.3969/j.issn.1673-8225.2010.17.043

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

老年股骨转子间骨折动力髋螺钉置入内固定失败行全髋关节置换4例

何双建，叶  峥，朱  剑，罗卫华，严  斌   

  1. 扬州大学附属泰兴市人民医院骨科，江苏省泰兴市      225400 
  • 出版日期:2010-04-23 发布日期:2010-04-23
  • 作者简介:何双建★，男，1975年生，江苏省泰兴市人，苏州大学附属第一医院在读硕士，主治医师，主要从事创伤骨科、关节外科研究。 hsjian.ok@163.com

Application of total hip replacement for intertrochanteric fractures following the failure of dynamic hip screw fixation in four elderly people  

He Shuang-jian, Ye Zheng, Zhu Jian, Luo Wei-hua, Yan Bin   

  1. Department of Orthopedics, Taixing People’s Hospital Affiliated to Yangzhou University, Taixing  225400, Jiangsu Province, China
  • Online:2010-04-23 Published:2010-04-23
  • About author:He Shuang-jian★, Studying for master’s degree, Attending physician, Department of Orthopedics, Taixing People’s Hospital Affiliated to Yangzhou University, Taixing 225400, Jiangsu Province, China hsjian.ok@163.com

PDF

469

被引次数

15

摘要：

背景：治疗股骨转子间骨折内固定的方法有动力髋螺钉、Gamma钉、股骨近端髓内钉、角钢板、股骨近段锁定钢板等，其中以动力髋螺钉应用最为广泛，但其失败率也逐渐增加。
目的：观察人工全髋关节置换治疗老年股骨转子间骨折应用动力髋螺钉内固定失败的病例特征。
方法：于2004/2007应用人工全髋关节置换治疗老年股骨转子间骨折动力髋螺钉内固定失败病例4例，患者为自行跌倒，按Evans分型，Ⅱ型1例，ⅢA 型2例，ⅢB型1例。动力髋螺钉置入后6个月~1年出现内固定物移位，股骨头切割，骨折不愈合，髋内翻畸形，髋部疼痛，不能行走。继之采用骨水泥髋臼假体，按45°外展角，10°~15°前倾角置入。人工全髋关节置换后按照Harris评分标准进行疗效评价。
结果与结论：4例患者手术顺利，手术时间1.5~2.0 h，术中出血量400~600 mL，未出现骨水泥过敏反应。置换后无切口感染，无脱位，无坠积性肺炎，无压疮。经3~12个月随访，未出现假体松动、下沉，髋关节功能满意，摄片人工关节在位，假体匹配良好，Harris评分平均81分。结果提示老年股骨转子间骨折动力髋螺钉内固定失败后应用人工全髋关节置换，可缩短患者卧床时间，减少并发症，改善髋关节功能。

关键词: 转子间骨折, 人工全髋关节置换, 动力髋螺钉, 内固定失败, 翻修

Abstract:

BACKGROUND: Many internal fixations, such as dynamic hip screw, Gamma screw, proximal femoral nail, angle steel plate, as well as locking proximac femoral plate, are utilized in treating intertrochanteric fractures, especially the dynamic hip screw. However, the failure rate is gradually increased.
OBJECTIVE: To explore the application and clinical efficacy of total hip replacement for the treatment of elderly intertrochanteric fracture fixation after failure of dynamic hip screw.
METHODS: A total of four cases with intertrochanteric fractures were treated by total hip replacement after failure of dynamic hip screw fixation was selected. According to Evans typing, one case were type Ⅱ, two cases were type Ⅲ A, and one case was type ⅢB. Internal fixation displacement could be found at half to 1 year after dynamic hip screw fixation. Because of bone disunion, coxa adducta and pain, the patients could not walk. Sequentially, total hip replacement was performed with 45° abduct angle and 10°-15° anteversion angle. The clinical efficacy was evaluated by Harris scoring criteria.
RESULTS AND CONCLUSION: All the cases were operated smoothly, with 1.5-2 hour operation duration and 400-600 mL blood loss. No case appeared allergic response to bone cement. By 3-12 months follow-up, 4 successful operative cases do not appear prosthesis loosening, subsidence and are satisfied with well hip function. The average Harris score were 81 points. The results revealed that application of total hip replacement after the failure of DHS in elderly intertrochanteric fracture fixation, which  shortened the time patients stay in bed to reduce complications and improved the hip joint function.

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