中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (22): 4176-4180.doi: 10.3969/j.issn.1673-8225.2010.22.046

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

骨质疏松性髋部骨折：不同金属植入物治疗的比较

张  寿，孔长庚，陈文远，丁晓莉   

  1. 中南大学湘雅医学院附属海口医院骨科中心，海南省海口市  570208
  • 出版日期:2010-05-28 发布日期:2010-05-28
  • 作者简介:张 寿，男，1955年生，教授，硕士生导师，主要从事骨质疏松性髋部骨折的治疗研究。
  • 基金资助:

    海南省自然科学基金资助项目(30323)。

Osteoporotic hip fracture: Comparison on various treatments of metal implants

Zhang Shou, Kong Chang-geng, Chen Wen-yuan, Ding Xiao-li   

  1. Orthopaedic Centre, Haikou People’s Hospital, Xiangya Medical College, Central South University, Haikou   570208, Hainan Province, China
  • Online:2010-05-28 Published:2010-05-28
  • About author:Zhang Shou, Professor, Master’s supervisor, Orthopaedic Centre, Haikou People’s Hospital, Xiangya Medical College, Central South University, Haikou 570208, Hainan Province, China bb3855@yahoo.com.cn
  • Supported by:

    the Natural Science Foundation of Hainan Province, No.30323*

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摘要：

背景：金属植入物内固定治疗年轻股骨颈骨折患者效果较好，但有关金属植入物治疗老年股骨颈骨折患者的效果较少见报道。
目的：比较采用不同金属植入物治疗老年骨质疏松性髋部骨折的效果。
方法：选择本院1998-01/2008-12老年骨质疏松性髋部骨折患者237例，年龄60~96岁。采用空心加压螺钉置入内固定治疗32例，解剖钢板置入内固定23例，动力髋螺钉置入内固定41例，双极股骨头置换111例，人工全髋关节置换30例。比较各组并发症发生率及髋关节功能恢复情况。
结果与结论：空心加压螺钉、解剖钢板、动力髋螺钉置入内固定治疗并发症发生率均高明显于双极股骨头置换、全髋关节置换治疗(P < 0.01)；空心螺钉组、股骨近端解剖钢板、动力髋螺钉置入内固定治疗优良率明显低于双极股骨头置换及全髋关节置换治疗(P < 0.001，P < 0.01)。结果提示老年骨质疏松性股骨颈骨折应首选人工关节置换(双极股骨头置换或全髋置换)，对Garden Ⅰ型可选用空心螺钉固定，转子间骨折Jensen-EvansⅠ~Ⅱ型可选用动力髋螺钉及股骨近端解剖型钢板置入内固定；Jensen-EvansⅡ~Ⅲ型骨质疏松性转子间骨折关节置换是理想的选择。

关键词: 老年, 骨质疏松, 髋部骨折, 金属置入物, 医学植入物

Abstract:

BACKGROUND: The metal implant internal fixation exhibits good effect for femoral neck fractures of young patients, but few studies report the metal implant treatment for femoral neck fracture in the aged patients.
OBJECTIVE: To compare different implant treatments for osteoporotic hip fractures in senile patients.
METHODS: A total of 237 aged patients with osteoporotic hip fracture, aged from 60 to 96 years old, were recruited from the hospital between January 1998 and December 2008. There were 32 cases treated by cannulated screw internal fixation, 23 cases by anatomical plate internal fixation, 41 cases by dynamic hip screw internal fixation, 111 cases by bipolar femoral head replacement, and 30 cases by total hip replacement. Comparison of the incidence of complications and the recovery of hip function were performed in each group.
RESULTS AND CONCLUSION: Cannulated screws, anatomical plates, dynamic hip screw internal fixation showed a higher complication rate significantly than bipolar femoral head replacement and total hip arthroplasty (P < 0.01); the good and excellent effect rate in cannulated screw, femoral end plate, and dynamic hip screw fixation was significantly lower than that in bipolar femoral head replacement and total hip arthroplasty (P < 0.001, P < 0.01). The results suggested that artificial joint replacement (bipolar femoral head replacement or total hip replacement) is the optimal choice for aged osteoporotic femoral neck fracture, cannulated screw fixation is suitable for Garden I, dynamic hip screw fixation and proximal femoral anatomical plate fixation fit for intertrochanteric fractures of Jensen-Evans I-Ⅱ; Jensen-Evans Ⅱ-Ⅲ osteoporotic intertrochanteric fractures joint replacement is the ideal choice. 

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