Chinese Journal of Tissue Engineering Research ›› 2017, Vol. 21 ›› Issue (23): 3760-3766.doi: 10.3969/j.issn.2095-4344.2017.23.026
Previous Articles Next Articles
Huang Guan-yu, Peng Hao
Online:
2017-08-18
Published:
2017-09-01
Contact:
Peng Hao, M.D., Professor, Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
About author:
Huang Guan-yu, Master, Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
CLC Number:
Huang Guan-yu, Peng Hao. Advance in the treatment of senile unstable intertrochanteric fractures[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(23): 3760-3766.
2.1 股骨转子间骨折的常用分型分型 股骨转子间骨折(Femoral intertrochanteric fracture)的分型有10种,较常用的有3种,分别为Evans分型,Evans-Jensen分型以及AO/OTA分型。 2.1.1 Evans分型[5] Evans根据骨折线方向将转子间骨折分为I型(骨折线向外上方延伸)和Ⅱ型(骨折线由小转子向外下方延伸)。其中,Ⅰ型又分为4种亚型,Ⅰa型骨折无位移,小转子无骨折,属于稳定型骨折;Ⅰb型小转子有骨折,内侧皮质有重叠,复位后皮质连续,属于稳定型骨折;Ⅰc型小转子有骨折,内侧皮质有重叠,复位后皮质不连续,属于不稳定型骨折;Ⅰd型大小转子均有骨折,呈粉碎性;Ⅱ型为逆转子骨折。 2.1.2 Evans-Jensen分型[6] 根据大小转子是否受累以及复位后是否稳定分为Ⅰ-Ⅴ型。Ⅰ型: 2部分骨折,骨折无移位;Ⅱ型:2部分骨折,骨折有移位;Ⅲ型: 3部分骨折,由于大转子骨折块移位而缺乏后外侧支持;Ⅳ型:3部分骨折,由于小转子或股骨矩骨折缺乏内侧支持;Ⅴ型:4部分骨折片段,缺乏内侧和外侧的支持,为Ⅲ型和Ⅳ型的结合。 2.1.3 AO/OTA分型[7-8] AO/OTA分型主要基于骨折块数量及骨折线方向进行分型,主要分为A1、A2、A3三型,每一型又分为3个亚型。A1型:经转子的简单骨折,内侧骨皮质有良好的支撑,外侧骨皮质完整;①沿转子间线;②通过大转子;③通过小转子。A2型:属于经转子的粉碎性骨折,外侧骨皮质完整,但内侧及后方骨皮质有破裂;①一块内侧骨折块;②多块内侧骨折块;③小转子下延伸超过1 cm。A3型:逆转子骨折,外侧骨皮质破裂;①斜形骨折线;②横行骨折线;③粉碎性。 2.2 股骨转子间骨折的治疗方式 股骨转子骨折治疗方式的选择主要依据其分型,Jin等[9]学者对40例患者使用AO、Evans、Kyle以及Boyd分型进行对比分析,发现AO/OTA分型Kappa值均值为0.82,可信度明显高于其它3种分型,因此AO/OTA分型对转子间骨折的诊断和治疗的指导意义更为可信。在AO/OTA分型中,A1型与A2-1型被定义为稳定型骨折,A2-2/3与A3型骨折被定义为不稳定型骨折[4]。 2.2.1 钉板系统 ①1941年Jewett报道了使用钉板系统治疗股骨转子间骨折,此类钢板与钉为一体,称为Jewett板,主要用于治疗稳定型的股骨转子间骨折。但Jewett板结构力学性能方面强度不足,无静力加压作用,尾钉较容易脱落,使得其断钉、松动及髋内翻等并发症发生率较高。因此Jewett板逐渐被淘汰;②1959年,瑞士AO学派提出使用AO/ASIF角度钢板治疗Evans Ic、Ⅰd型及Ⅱ型骨折,AO/ASIF角度钢板有较好的抗股骨头旋转能力以及结构力学强度,但角钢板内固定手术操作繁琐,手术技术要求较高,并且在生物力学特性上有着不可忽视的弊端,曾有生物力学研究显示角度钢板一次性载负仅40 kg,因此角钢板逐渐被淘汰;③在20世纪70年代,动力髋螺钉(dynamic hip screw,DHS)广泛应用于治疗股骨转子间骨折,动力髋螺钉可较好的恢复颈干角,有效防止髋内翻。并且由于动力髋螺钉存在滑动加压以及静力加压的双重作用,也有利于骨折愈合。由于动力髋螺钉良好的疗效以及操作较为简便,曾一度被定义为治疗股骨转子间骨折的“金标准”[10]。但动力髋螺钉在治疗高龄患者的不稳定型骨折时,尤其是股骨大转子外侧壁不完整,或伴有后内侧股骨距粉碎的患者时,动力髋螺钉内固定的失败率显著增高。随着动力髋螺钉术后并发症的随访研究不断深入,发现动力髋螺钉抗旋能力较为不足;也可出现主钉的轴向滑动,导致股骨颈短缩以及肢体短缩。动力髋螺钉在治疗不稳定型转子间骨折时,尤其是内侧皮质缺损的患者,内置物承受的内翻应力明显增大,易出现内置物疲劳断裂,导致髋内翻的发生率增加。其他研究也显示,动力髋螺钉在治疗不稳定型股骨转子间骨折时,术后主钉穿透或切出股骨头、骨折延迟或不愈合、钢板断裂等并发症发生率较高[11]。随着髓内固定技术的不断成熟,动力髋螺钉治疗不稳定型骨折时并发症发生率较高,使得动力髋螺钉的使用率逐渐下降,但在治疗稳定型骨折时仍有使用。 2.2.2 髓内固定系统 ①Gamma钉:Gamma钉由主钉、拉力螺钉以及远端锁定3部分组成,通过髓内固定以及拉力螺钉的作用可获得良好疗效,与动力髋螺钉相比具有切口小,操作简便、出血量少等优势。但Gamma钉在设计上外翻角度为10°,使得应力集中于与主钉尾端接触的股骨外侧皮质上,导致并发股骨干骨折的风险明显上升。当术中扩髓不充分时,若强行打入主钉,有可能会导致股骨干的爆裂骨折。Gamma钉的拉力螺钉仅有一枚,导致其抗旋能力也较为不足;②股骨近端髓内钉(proximal femoral nail,PFN):股骨近端髓内钉作为Gamma钉的改良版本,其增加了1枚拉力螺钉来进一步提高抗股骨头旋转的作用,并且降低了拉力螺钉断钉的风险。在主钉的设计上,主钉外翻角度为6°,使主钉的生物力学特性更高,显著的降低了股骨干骨折的风 险[12]。主钉整体直径更细,部分患者可不扩髓即可插入,减少了因扩髓而导致的失血。然而股骨近端髓内钉仍存在拉力螺钉切出股骨头、内固定松动等风险[13];③股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA):股骨近端防旋髓内钉以1枚螺旋刀片替代股骨近端髓内钉的2枚拉力螺钉,进一步的提高了抗股骨头旋转的作用,在主钉的设计上与股骨的生理结构更加匹配,减少了内固定物周围骨折的风险;相比股骨近端髓内钉,股骨近端防旋髓内钉在手术时间及出血量上进一步降低,并可适用于股骨头较小的患者。但股骨近端防旋髓内钉手术需要良好的股骨头复位后才打入螺旋刀片,因此对手术医生的手术技巧要求较高。现阶段稳定型转子间骨折的治疗策略主要为使用动力髋螺钉或髓内钉(intramedullary nail,IMN)进行内固定。不稳定型转子间骨折的治疗方式主要为股骨近端防旋髓内钉。 人工髋关节置换:主要包括人工股骨头置换和全髋关节置换(total hip arthroplasty,THA)。①人工股骨头置换术仅进行股骨头的置换,相比全髋关节置换,不需打磨髋臼,降低了手术时间以及术中出血量;②全髋关节置换需进行髋臼的打磨,并且需保证良好的前倾角和外倾角,需要手术医生进行充分的术前准备和手术经验;若为转子间骨折伴有退行性髋关节疾病的患者,在严格把握适应证的情况下,可选择行全髋关节置换。人工髋关节置换作为一种假体植入的手术,假体周围骨折、血栓栓塞、假体松动、髋关节脱位以及假体磨损等是其特有的并发症,因此需把握严格的手术适应证。 现阶段,老年人不稳定型股骨转子间骨折主要采用股骨近端防旋髓内钉进行治疗。有学者提出,人工髋关节置换可作为治疗不稳定型转子间骨折一种有效而可行的方法。本文将对老年人不稳定型股骨转子间骨折的治疗进行综述。 2.3 髓内钉与关节置换术治疗老年人不稳定型股骨转子间骨折的对比 2.3.1 股骨近端防旋髓内钉 股骨近端防旋髓内钉作为股骨近端髓内钉的改良版本,其特点在于使用一枚螺旋刀片替代了股骨近端髓内钉的头颈螺钉。 股骨近端防旋髓内钉的优势:①螺旋刀片直接敲入股骨头,对钉道周围骨质起到了压缩的作用,减少了骨量的丢失,在Lenich等[14]的研究中,股骨近端髓内钉头颈螺钉的切出率高达14%,相比之下股骨近端防旋髓内钉的切出率只有5.7%;②股骨近端防旋髓内钉的螺旋刀片抗旋转及抗内翻能力强于股骨近端髓内钉;③股骨近端防旋髓内钉手术过程简便,创伤小,失血量小。但是,老年人常伴有重度的骨质疏松症,使得骨质愈合能力差、骨质强度低,随着股骨近端防旋髓内钉广泛应用于治疗高龄患者的不稳定型转子间骨折。 股骨近端防旋髓内钉的不足:①股骨近端防旋髓内钉在治疗高龄不稳定型骨折时,疗效不确切。在Hélin 等[15]学者的研究中,股骨近端防旋髓内钉在治疗高龄不稳定型转子间骨折时,骨折块复位不良的概率高达45%,股骨颈短缩的的均值达(8.1±8.4) mm,通过Parker Score结果发现股骨近端防旋髓内钉术后并发症发生率较高[12];②股骨近端防旋髓内钉的螺旋刀片向上方切出的距离方面,不稳定型为(2.3±6.0) mm,稳定型为(0.5±2.6) mm[16];③螺旋刀片有向内穿透的风险。Brunner等[17]的研究中,12例高龄不稳定型骨折患者使用股骨近端防旋髓内钉治疗,发生了3例螺旋刀片向内穿透股骨头。Simmermacher等[18]的研究中,有4例患者股骨近端防旋髓内钉的螺旋刀片穿入了髋臼。在Feri等[19]的报道中,有7例患者发生了螺旋刀片穿透股骨头。高龄不稳定型转子间骨折的患者,尤其是股骨近端内侧壁缺乏支撑并伴有大转子外侧壁缺损的患者,螺旋刀片向内穿出的风险明显增大[20];④高龄患者常伴有重度骨质疏松症,股骨近端防旋髓内钉未能降低骨折延迟愈合或不愈合的风险,在Makki等[21]的研究中,对36例AO/OTA A3型的患者使用股骨近端防旋髓内钉进行治疗,有6例患者患者在术后6-12个月骨折愈合,有2例患者的愈合时间大于12个月,有8例患者最终股骨近端防旋髓内钉固定失败;⑤相比动力髋螺钉,股骨近端防旋髓内钉内置物周围骨折发生率更高。在Müller等[22]的研究中,597例使用动力髋螺钉治疗的患者发生内置物周围骨折的比例为3/597(0.5%),在705例行股骨近端防旋髓内钉治疗的患者中,内置物周围骨折的比例为15/705 (2.1%)。 2.3.2 人工髋关节置换 人工髋关节置换术普遍应用于治疗年龄大于60岁患者的股骨颈骨折、股骨头缺血性坏死、先天性髋臼发育不良以及髋关节骨性关节炎等疾病。人工髋关节置换术主要分为两类,分别为人工股骨头置换和全髋关节置换。其优势之处在于,关节置换术后,患者无需等待骨折愈合即可早期下床进行功能锻炼。可降低因长期卧床而导致的肺部感染、压疮以及肺栓塞等并发症的发生。并且早期进行患肢功能康复训练,可促进患者功能最大限度地恢复,提高患者的生活质量。随着人工髋关节假体的不断革新和完善以及临床医生髋关节置换术技术的纯熟,部分老年人不稳定型转子间骨折使用人工髋关节置换术进行治疗,并获得满意疗效。但人工关节置换术与股骨近端防旋髓内钉内固定术相比,创口较大、出血量较多且费用较高等,因此需要严格把握其适应证和禁忌证,并且做好充分的术前准备。 人工髋关节置换治疗转子间骨折的适应证:①不稳定型骨折合并重度骨质疏松症;②同侧髋关节骨性关节炎;③同侧股骨头缺血性坏死;④不稳定型骨折合并先天性髋臼发育不良;⑤股骨近端防旋髓内钉等内固定术失败。 人工髋关节置换治疗转子间骨折的禁忌症:①患者有严重的内科合并症无法耐受关节置换术,如严重的心力衰竭、难以控制的高血压以及严重的心肺功能不全等;②患者术前有严重贫血,无法耐受关节置换术的出血量;③患者合并有同侧髋关节感染或是髋关节周围存在皮肤疾病;④同侧髋部因其他原因导致严重的肌力下降或肌力丧失;⑤同侧下肢患有严重的血管性疾病。 人工股骨头置换和全髋关节置换的选择:不合并髋臼病变的不稳定型转子间骨折可使用人工股骨头置换治疗,以降低术中出血量、手术时间以及围术期的风险。若合并有同侧髋关节骨性关节炎、先天性髋臼发育不良或是股骨近端防旋髓内钉螺旋刀片向内穿透髋臼等,应行全髋关节置换治疗。 2.4 人工髋关节置换术治疗股骨转子间骨折的要点 2.4.1 假体类型和选择 用于治疗不稳定型转子间骨折的假体可分为3类。①骨水泥型近端固定假体;②非骨水泥型近端固定假体;③Wagner远端固定假体。无论骨水泥型或是非骨水泥型假体,均成功运用于临床治疗不稳定型转子间骨折。骨水泥的优点在于:可以立即获得稳定,不需等待骨长入,并且可以获得满意的中远期疗效[23];骨水泥型假体适用于股骨干皮质较薄的老年患者,或是因转子粉碎性骨折需要进行股骨距重建的患者[4]。但是随着骨水泥的广泛应用,骨水泥相关的并发症也逐渐被发现,如:低血压、缺氧以及因髓内压迫导致的脂肪栓塞等[24-27]。Herrenbruck等[28]研究发现,心肺功能不全的患者在进行骨水泥填塞的过程中,更易发生骨水泥相关并发症。在Parvizi等[29]学者的研究中,在使用骨水泥型假体治疗转子间骨折的患者时,由于骨水泥相关并发症而导致患者术中死亡的比例为1.6%。非骨水泥型假体在近年来受到普遍的应用,其优势在于有效的避免了骨水泥相关并发症,并降低手术时间以及术中出血量,而在短期假体功能、并发症发生率以及患者死亡率方面,非骨水泥型假体依旧有良好表现[30-32]。其争议之处在于假体松动以及假体周围骨折的发生率有可能提高[33],尤其是重度骨质疏松的患者。但Berend以及Pieringer等[34-35]研究发现,使用非骨水泥型假体未增加因假体松动而导致手术失败的概率,Cankaya等[36]学者经过2年随访的研究也支持了这一观点。Wagner等[37]假体是一种以远端固定为主的假体,其假体柄有8条纵行突起的设计,有效的增加了假体与髓腔接触界面的面积,其间粗糙界面以及嵴间的沟槽促进骨面的整合以及血管的再生,使得假体早期的稳定性来自假体柄与股骨髓腔的压配,而远期假体的稳定性依靠的是骨整合及长入。 2.4.2 手术入路的选择 目前较为常用的手术入路为直接外侧入路以及后外侧入路。后外侧入路进入髋关节是需离断梨状肌、上下孖肌、闭孔内外肌以及股方肌等外旋肌,术后应进行外旋肌的修复,以期获得更好的髋关节稳定性及良好的功能重建。直接外侧入路相比后外侧入路对肌肉的损伤较小,不损伤梨状肌、上下孖肌、闭孔内外肌以及股方肌等外旋肌。而直接外侧入路需做大转子截骨,Francois Steffann等[38]学者提出,与Bombaci截骨入路不同,他们采用大转子顶端截骨,其纵行截骨线起自大转子顶端中后1/3,下至转子窝,将大转子分为不均等的两部分,横行截骨线由大转子后侧起始,止于与纵向截骨线相交处。Francois Steffann等[38]学者认为,此截骨方法有利于保留外展肌群的功能完整性,并且缩短了术后患者完全负重所需的时间。在手术入路的选择上,可根据临床医生的熟悉程度进行选择。 2.4.3 外展肌的保护以及大转子的重建 外展肌尤其是臀中肌的保护,在术中应受到重视。臀中肌止于股骨大转子,其主要功能是股骨的外展,并且臀中肌的完整性是髋关节稳定性的重要因素。在术中应保护臀中肌及其止点,在进行大转子的重建时,应注意臀中肌止点是否受损,若有损伤则应及时修复。对于大转子的重建,可使用钢丝环扎固定;若大转子粉碎严重,骨折块不易进行环扎,可使用不吸收缝线进行8字缝扎,从而达到修复大转子功能的目的。 2.4.4 围术期管理 术前应重视对患者围术期风险的评估,对患者全身系统进行检查,尤其是心肺功能。严格把握手术的适应证,对伴有严重内科疾病的患者,应积极处理内科疾病,以求最大限度降低围术期风险。人工股骨头置换和全髋关节置换后的患者应按指南常规使用抗凝药物,防止术后因下肢深静脉血栓形成导致的肺栓塞以及脑栓塞等严重并发症的发生[39]。术前可给予患者超前镇痛,术后给予患者充分止痛,并鼓励患者早期进行患肢功能锻炼,如踝泵功能锻炼以及股四头肌功能锻炼等。患者应尽量避免髋关节内收或双下肢交叉等动作,以防止髋关节脱位。患者早期可在助行器或双拐保护下逐渐负重行走。行大转子截骨的患者,需限制其自主外展活动6-8周。 "
[1] Stevens JA, Rudd RA. The impact of decreasing U.S. hip fracture rates on future hip fracture estimates.Osteoporosis Int.2013;24(10):2725-2728.[2] Özkay?n N, Okçu G, Aktu?lu K. Intertrochanteric femur fractures in the elderly treated with either proximal femur nailing or hemiarthroplasty: A prospective randomised clinical study . Injury-international J Care Injured.2015;3:3-8.[3] Sidhu A S, Singh A P, Singh A P, et al. Total hip replacement as primary treatment of unstable intertrochanteric fractures in elderly patients.Int Orthopaedics.2009;34(6):789-792.[4] Mäkinen T J, Gunton M, Fichman S G, et al. Arthroplasty for Pertrochanteric Hip Fractures. Orthop Clin North Am.2015;46(4):433-444.[5] Evans EM. The treatment of trochanteric fractures of the femur. Bone Joint J. 1949;31(2):190-203.[6] Jensen JS, Sonne-Holm S, TØbndevold E.Unstable trochanteric fractures: a comparative analysis of four methods of internal fixation. Acta orthop Scandinavica.1980;51(1-6): 949-962.[7] Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma.2007;21(10 Suppl):1-133.[8] 朱江涛,卫小春. 股骨转子间骨折分型[J]. 实用骨科杂志, 2007, 13(07):410-413.[9] Jin W J, Dai L Y, Cui Y M, et al. Reliability of classification systems for intertrochanteric fractures of the proximal femur in experienced orthopaedic surgeons.Injury-international J Care Injured.2005;36(7):858-861.[10] Radford PJ, Needoff M, Webb JK. A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone J Sur British.1993;75(5):789-93.[11] Adams CI, Robinson CM, Court-Brown CM, et al. Prospective Randomized Controlled Trial of an Intramedullary Nail Versus Dynamic Screw and Plate for Intertrochanteric Fractures of the Femur. J Orthop Trauma.2001;15(6):394-400.[12] Boldin C, Seibert F J, Fankhauser F, et al. The proximal femoral nail (PFN)--a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthopaedica Scandinavica.2003;74(1):53-58.[13] Uzun M, Ertürer E, Oztürk I, et al. [Long-term radiographic complications following treatment of unstable intertrochanteric femoral fractures with the proximal femoral nail and effects on functional results]. Acta Orthopaedica Et Traumatologica Turcica.2009;43(6):457-63.[14] Lenich A, Vester H, Nerlich M, et al. Clinical comparison of the second and third generation of intramedullary devices for trochanteric fractures of the hip-Blade vs screw. Injury-international J Care Injured.2010;41(12):1292-1296. [15] Hélin M, Pelissier A, Boyer P, et al. Does the PFNA™ nail limit impaction in unstable intertrochanteric femoral fracture? A 115 case-control series. Orthopaedics & Traumatology Surgery & Res.2015;101(1):45-9.[16] Parker M J, Palmer C R. A new mobility score for predicting mortality after hip fracture.J Bone Joint Sur British.1993;75(5):797-8.[17] Brunner AM, Babst RM. The PFNA proximal femur nail in treatment of unstable proximal femur fractures--3 cases of postoperative perforation of the helical blade into the hip joint. J Orthop Trauma.2008;22(10):731-736.[18] Simmermacher R K J, Ljungqvist J, Bail H, et al. The new proximal femoral nail antirotation (PFNA ) in daily practice: Results of a multicentre clinical study[J]. Injury-international J Care Injured.2008;39(8):932-939.[19] Frei HC, Hotz T, Cadosch D, et al. Central head perforation, or "cut through," caused by the helical blade of the proximal femoral nail antirotation. J Orthop Trauma.2012;26(8):102-7.[20] 李海丰,张世民. 股骨近端防旋髓内钉螺旋刀片向内穿出的研究进展[J].中华创伤骨科杂志, 2013, 15(5):442-444.[21] Makki D, Matar HE, Jacob N, et al. Comparison of the Reconstruction Trochanteric Antigrade Nail (TAN) with the Proximal Femoral Nail Antirotation (PFNA) in the Management of Reverse Oblique Intertrochanteric Hip Fractures. Injury-international J Care Injured.2015;46(12):2389-2393.[22] Müller F, Galler M, Zellner M, et al. Peri-implant femoral fractures: The risk is more than three times higher within PFN compared with DHS. Injury-international J Care Injured.2016.[23] Maurer SG, Baitner AC, Di CP. Reconstruction of the failed femoral component and proximal femoral bone loss in revision hip surgery. Journal of the American Academy of Orthopaedic Surgeons.2000;8(6):354-63.[24] Donaldson AJ, Thomson HE, Harper NJ, et al. Bone cement implantation syndrome. British J Anaesthesia.2009;102(1): 404-418.[25] Parvizi J, Ereth MH, Lewallen DG.Thirty-day mortality following hip arthroplasty for acute fracture. J Bone Joint Surg.2004;86-A(9):1983-8.[26] Christie J, Burnett R, Potts H R, et al. Echocardiography of transatrial embolism during cemented and uncemented hemiarthroplasty of the hip. J Bone Joint Surg.1994; 76(3): 409-412.[27] Hossain M, Andrew J G. Is there a difference in perioperative mortality between cemented and uncemented implants in hip fracture surgery? Injury-international J Care Injured.2012;43(12):2161-4.[28] Herrenbruck T, Erickson E W, Damron T A, et al. Adverse clinical events during cemented long-stem femoral arthroplasty. Clinical Orthopaedics & Related Res. 2002; 395(395):154-63.[29] Parvizi J, Holiday A D, Ereth M H, et al. The Frank Stinchfield Award. Sudden death during primary hip arthroplasty. Clin Orthop Related Res.1999;69(369):39-48.[30] Deangelis J P, Ademi A, Staff I, et al. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: a prospective randomized trial with early follow-up. J Orthop Trauma.2012;26(3):135-140.[31] Taylor F, Wright M, Zhu M. Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. J Bone Joint Surg.2012; 94(7):577-583.[32] Figved W, Opland V, Frihagen F, et al. Cemented versus Uncemented Hemiarthroplasty for Displaced Femoral Neck Fractures. Clinical Orthop Related Res.2009; 467(9): 2426-2435.[33] Parker MJ, Handoll HH. Replacement arthroplasty versus internal fixation for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2000;(2):CD000086.[34] Berend KR, Lombardi AV, Mallory TH, et al. Cementless double-tapered total hip arthroplasty in patients 75 years of age and older 1. J Arthroplasty.2004; 19(3):288-295.[35] Pieringer H, Labek G, Auersperg V, et al. Cementless total hip arthroplasty in patients older than 80 years of age. Bone Joint J. 2003;85(5):641-645.[36] Cankaya D, Ozkurt B, Tabak A Y. Cemented calcar replacement versus cementless hemiarthroplasty for unstable intertrochanteric femur fractures in the elderly. TJTES.2013; 19(19):548-553.[37] Böhm P, Bischel O. The use of tapered stems for femoral revision surgery. Clin Orthop Related Res.2004; 420(420): 148-59.[38] Francois S, Jean-Louis P, Jean-Marc P, et al. Trans trochanteric approach with coronal osteotomy of the great trochanter:A new technique for extra-capsular trochanteric fracture patients treated by total hip arthroplasty (THA) in elderly. SICOT-J, 2015, 1.[39] Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. CHEST J.2012;141(2_suppl): e278S-e325S.[40] Kim SY, Kim YG, Hwang JK. Cementless calcar-replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures. A prospective, randomized study. J Bone & Joint Surgery American Volume. 2005; 87(10):2186-2192.[41] Khaldoun Sinno, Mazen Sakr, Julien Girard, Hassan Khatib. The effectiveness of primary bipolar arthroplasty in treatment of unstable intertrochanteric fractures in elderly patients.North Am J Med Sci.2010;2(12):561-568.[42] Bonnevialle P, Saragaglia D, Ehlinger M, et al. Trochanteric locking nail versus arthroplasty in unstable intertrochanteric fracture in patients aged over 75 years ☆. Orthopaedics & Traumatology Surgery & Research.2011;97(6 Suppl):95-100.[43] Shen J, Wang DL, Chen GX, et al. Bipolar hemiarthroplasty compared with internal fixation for unstable intertrochanteric fractures in elderly patients. J Orthop Science Official.2012; 17(6):722-729.[44] Mustafa C, Emre T, Ozkan K. Calcar Preservation Arthroplasty for Unstable Intertrochanteric Femoral Fractures in Elderly. Clin Orthop Surg. 2015;7(4):436-442.[45] Sidhu A S, Singh A P, Singh AP, et al. Total hip replacement as primary treatment of unstable intertrochanteric fractures in elderly patients.Int Orthopaedics. 2009;34(6):789-792.[46] Yamanaka Y, Ito H. Incidence of Venous Thromboembolism in Patients Undergoing Major Hip Surgeries at a Single Institution: A Prospective Study.Open Orthopaedics J.2016;10: 252.[47] 张长青.关于老年股骨转子间骨折的当代观点[J]. 中华骨科杂志, 2012, 32(7):611-613. |
[1] | Yao Xiaoling, Peng Jiancheng, Xu Yuerong, Yang Zhidong, Zhang Shuncong. Variable-angle zero-notch anterior interbody fusion system in the treatment of cervical spondylotic myelopathy: 30-month follow-up [J]. Chinese Journal of Tissue Engineering Research, 2022, 26(9): 1377-1382. |
[2] | Xue Yadong, Zhou Xinshe, Pei Lijia, Meng Fanyu, Li Jian, Wang Jinzi . Reconstruction of Paprosky III type acetabular defect by autogenous iliac bone block combined with titanium plate: providing a strong initial fixation for the prosthesis [J]. Chinese Journal of Tissue Engineering Research, 2022, 26(9): 1424-1428. |
[3] | Zhuang Zhikun, Wu Rongkai, Lin Hanghui, Gong Zhibing, Zhang Qianjin, Wei Qiushi, Zhang Qingwen, Wu Zhaoke. Application of stable and enhanced lined hip joint system in total hip arthroplasty in elderly patients with femoral neck fractures complicated with hemiplegia [J]. Chinese Journal of Tissue Engineering Research, 2022, 26(9): 1429-1433. |
[4] | Zhang Lichuang, Xu Hao, Ma Yinghui, Xiong Mengting, Han Haihui, Bao Jiamin, Zhai Weitao, Liang Qianqian. Mechanism and prospects of regulating lymphatic reflux function in the treatment of rheumatoid arthritis [J]. Chinese Journal of Tissue Engineering Research, 2022, 26(9): 1459-1466. |
[5] | An Weizheng, He Xiao, Ren Shuai, Liu Jianyu. Potential of muscle-derived stem cells in peripheral nerve regeneration [J]. Chinese Journal of Tissue Engineering Research, 2022, 26(7): 1130-1136. |
[6] | Zhang Jinglin, Leng Min, Zhu Boheng, Wang Hong. Mechanism and application of stem cell-derived exosomes in promoting diabetic wound healing [J]. Chinese Journal of Tissue Engineering Research, 2022, 26(7): 1113-1118. |
[7] | Xu Kuishuai, Zhang Liang, Chen Jinli, Ren Zhongkai, Zhao Xia, Li Tianyu, Yu Tengbo. Effect of force line changes on lower limb joints after medial open wedge high tibial osteotomy [J]. Chinese Journal of Tissue Engineering Research, 2022, 26(6): 821-826. |
[8] | Shao Yangyang, Zhang Junxia, Jiang Meijiao, Liu Zelong, Gao Kun, Yu Shuhan. Kinematics characteristics of lower limb joints of young men running wearing knee pads [J]. Chinese Journal of Tissue Engineering Research, 2022, 26(6): 832-837. |
[9] | Huang Hao, Hong Song, Wa Qingde. Finite element analysis of the effect of femoral component rotation on patellofemoral joint contact pressure in total knee arthroplasty [J]. Chinese Journal of Tissue Engineering Research, 2022, 26(6): 848-852. |
[10] | Yuan Jing, Sun Xiaohu, Chen Hui, Qiao Yongjie, Wang Lixin. Digital measurement and analysis of the distal femur in adults with secondary knee valgus deformity [J]. Chinese Journal of Tissue Engineering Research, 2022, 26(6): 881-885. |
[11] | Zhou Jianguo, Liu Shiwei, Yuan Changhong, Bi Shengrong, Yang Guoping, Hu Weiquan, Liu Hui, Qian Rui. Total knee arthroplasty with posterior cruciate ligament retaining prosthesis in the treatment of knee osteoarthritis with knee valgus deformity [J]. Chinese Journal of Tissue Engineering Research, 2022, 26(6): 892-897. |
[12] | Wang Shaoling, Wang Yanxue, Zheng Yaochao, Yu Shaojun, Ma Chao, Wu Shaoling. Feasibility of ultrasound-guided intra-articular injection in rabbit hip joint [J]. Chinese Journal of Tissue Engineering Research, 2022, 26(5): 657-662. |
[13] | Lu Qinxue, Xu Ning, Yang Yinglan, Han Qianqian, Duanmu Xianyu, Guo Yuwei, Han Qing. Femoroacetabular impingement: strength trainings for nerve-muscle, peripheral muscle and core muscle [J]. Chinese Journal of Tissue Engineering Research, 2022, 26(5): 786-791. |
[14] | Tang Jiping, Zhang Yeting. Exercise regulates adult hippocampal neurogenesis in Alzheimer’s disease: mechanism and role [J]. Chinese Journal of Tissue Engineering Research, 2022, 26(5): 798-803. |
[15] | Chen Xiaoxu, Luo Yaxin, Bi Haoran, Yang Kun. Preparation and application of acellular scaffold in tissue engineering and regenerative medicine [J]. Chinese Journal of Tissue Engineering Research, 2022, 26(4): 591-596. |
Viewed | ||||||
Full text |
|
|||||
Abstract |
|
|||||