中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (26): 4870-4873.doi: 10.3969/j.issn.1673-8225.2010.26.030

• 骨与关节学术探讨 academic discussion of the bone and joint • 上一篇    下一篇

人工股骨头置换与内固定治疗高龄股骨转子间骨折疗效的比较

杜广宇，赵文志，何盛为，方  旭，米立东，孙传秀，张  路，孙雪刚   

  1. 大连医科大学第二附属医院骨科，辽宁省大连市  116023
  • 出版日期:2010-06-25 发布日期:2010-06-25
  • 作者简介:杜广宇，男，1978年生，辽宁省西丰县人，汉族，2007年贵阳医学院毕业，硕士，主治医师，主要从事创伤和关节损伤方面的研究。 Duguangyu2008@163.com

Treatment effects of artificial femoral head replacement versus internal fixation on elderly intertrochanteric fractures

Du Guang-yu, Zhao Wen-zhi, He Sheng-wei, Fang Xu, Mi Li-dong, Sun Chuan-xiu, Zhang Lu, Sun Xue-gang   

  1. Department of Orthopedics, Second Hospital of Dalian Medical University, Dalian  116023, Liaoning Province, China
  • Online:2010-06-25 Published:2010-06-25
  • About author:Du Guang-yu, Master, Attending physician, Department of Orthopedics, Second Hospital of Dalian Medical University, Dalian 116023, Liaoning Province, China Duguangyu2008@ 163.com

PDF

462

被引次数

28

摘要：

目的：比较人工股骨头置换与内固定治疗高龄股骨转子间骨折并探讨其临床适应证。
方法：以“人工髋关节，转子间骨折，内固定”为中文关键词；“Hip replacement，Intertrochanteric Fractures, Internal Fixations”为英文关键词。采用计算机检索1969-01/2009-10相关文章。纳入与有关生物材料与组织工程材料相关的文章；排除重复研究或Meta分析类文章。以10篇文献为重点进行了讨论。临床验证选择大连医科大学第二附属医院骨外科收治的168例75岁以上不稳定型股骨转子间骨折的患者，分别采用人工股骨头置换和内固定方法治疗。分别对两组患者的手术时间、失血量、术后并发症、卧床时间、髋关节功能恢复结果、住院时间进行比较。
结果：高龄股骨转子间骨折临床上多以采用内固定为主，对是否行人工股骨头置换仍存在争议。目前，人工髋关节假体材料主要有钴合金和钛合金、聚乙烯、多孔聚砜类物、多缩醛类树脂、碳素等材料。主要采取的固定方式有：骨水泥型假体、生物型假体、骨水泥型与生物型假体互补及现代骨水泥技术。经临床验证，人工股骨头置换在手术时间、置换后并发症、卧床时间、住院时间均好于内固定方法(P < 0.05)；置换后1，3，6个月髋关节功能恢复优于内固定方法(P < 0.05)，置换后12个月两种方法差异无显著性意义(P > 0.05)。
结论：人工股骨头置换治疗高龄不稳定型股骨转子间骨折具有置换后恢复好、能早期负重、并发症少等近期疗效好的优点，其远期并发症有待观察和进一步研究解决。

关键词: 股骨转子间骨折, 关节置换, 内固定, 老年人, 假体材料

Abstract:

OBJECTIVE: To compare artificial femoral head replacement and internal fixation in treating elderly intertrochanteric fractures, and explore the indications.

METHODS: A computer-based online search was performed for articles published between January 1969 and October 2009 with the key words “hip replacement, intertrochanteric fractures, internal fixations” in English. Articles related with biomaterials and tissue engineered materials were included. Repetitive studies or Meta analysis were excluded. A total of 10 articles were discussed. A total of 168 patients, aged over 75 years, were selected from Department of Orthopedics, Second Hospital of Dalian Medical University and treated with artificial femoral head replacement and internal fixation. The operation time, bleeding, postoperative complications, bed stay duration, hip functional recovery, and hospitalization duration were compared.

RESULTS: Elderly intertrochanteric fractures have been majorly treated by internal fixation. It remains controversial whether artificial femoral head replacement is necessary. Currently, artificial hip prosthesis materials include cobalt alloy and titanium alloy, polyethylene, porous polysulfones, acetal resinoid, and carbon. The internal fixation patterns include cement-typed prosthesis, biotype prosthesis, their combination, and modern cement technique. Clinical results show that artificial femoral head replacement displayed advantages in operation time, postoperative complications, bed stay duration, and hospitalization duration compared with internal fixation (P < 0.05). The hip functional recovery was superior to internal fixation at 1, 3, and 6 months postoperatively (P < 0.05), but no differences were observed at 12 months postoperatively (P > 0.05).

CONCLUSION: Artificial femoral head replacement has advantages of early postoperative recovery, early weight loading and few complications in treating elderly intertrochanteric fractures compared with the internal fixation. However, the long-term complications require further observation.

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