| 陶钧,许克庆,吴成玉,等.生物型长柄人工股骨头置换术治疗90岁以上 Evans Ⅲ~Ⅳ型股骨粗隆间骨折 22例[J].安徽医药,2020,24(2):275-280. |
| 生物型长柄人工股骨头置换术治疗90岁以上 Evans Ⅲ~Ⅳ型股骨粗隆间骨折 22例 |
| Curative effect analysis on biological long?stem artificial femoral head replacement for the treatment of EvansⅢ~Ⅳ intertrochanteric fracture of femur over 90 years old |
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| DOI：10.3969/j.issn.1009?6469.2020.02.016 |
| 中文关键词: 髋骨折 关节成形术，置换，髋 骨固定钢丝 老年人， 80以上 |
| 英文关键词: Hip Fractures Arthroplasty,replacement,hip Bone wires Aged,80 and over |
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| 中文摘要: |
| 目的探讨生物型长柄人工股骨头置换术治疗 90岁以上 Evans Ⅲ~Ⅳ型股骨粗隆间骨折的手术方法和临床疗效。方法回顾性分析 2015年 1月至 2016年 11月淮南市第一人民医院高龄股骨粗隆间骨折病人 22例，术前 X线及三维重建 CT确诊为 Evans分型为 Ⅲ~Ⅳ型。所有病人均采用髋关节后外侧入路，先安装生物型长柄人工股骨头，其次复位股骨粗隆间的骨折断端，断端复位满意后采用钢丝捆扎来稳定维持骨折位置。所有病人术前评估以及术后随访均采用视觉模拟量表( VAS)评分系统以及髋关节 Harris评分系统。结果所有病人均获得随访，随访时间为( 13.36±1.76)月。本组病人术后切口均 Ⅰ期愈合；无术中、术后死亡；均在术后早期［术后( 2.23±0.61)d］即下床扶助行器行走；术后未见压疮、肺部感染、泌尿系统感染、下肢深静脉血栓等并发症；末次随访未见假体松动及髋关节脱位等严重并发症。术后 2周 VAS评分( 3.82±1.01)分和髋关节 Harris评分( 67.95±5.79)分，较术前 VAS评分( 8.86±0.77)分和髋关节 Harris评分( 28.09±4.21)分，差异有统计学意义( P＜0.01)且和末次随访时 VAS评分( 0.41±0.59)分和髋关节 Harris评分( 91.14±5.69)分相比，差异有统计学意义( P＜0.01)髋关节 Harris评，分系统评价:痊愈 14例、显效 7例、有效 1例，显效率达 95.45％。结论生物型长柄人工股骨头置换术治疗 90岁以，上 Evans Ⅲ~Ⅳ型股骨粗隆间骨折，其操作简单易行、术后可早期下床活动、降低骨折并发症、临床疗效满意。 |
| 英文摘要: |
| Objective To investigate the surgical method and clinical effect of long?stem artificial femoral head replacement in thetreatment of Evans type Ⅲ~Ⅳ intertrochanteric fracture over 90 years old.Methods A retrospective analysis was made on 22 cas?es of intertrochanteric fracture of femur in our hospital from January 2015 to November 2016.Preoperative X?ray and three?dimen?sional reconstruction CT confirmed Evans classification Ⅲ~Ⅳ.All cases were treated by posterolateral approach of hip joint，first in? stalling long?stem artificial femoral head，then reducing intertrochanteric fracture of femur，and then internal fixation with steel wire. The hip function was evaluated by VAS score and Harris score before and after operation.Results All patients were followed up for an average of(13.36±1.7)months.All the incisions healed in phase I without death during and after the operation.All patientsgot out of bed and walked with walking aids early after operation(2.23±0.61days after operation).No complications such as pres? sure ulcer，pulmonary infection，urinary system infection，deep venous thrombosis of lower extremities were found.No serious compli?cations such as prosthesis loosening and hip dislocation were found in the last follow?up.Two weeks after operation，VAS score(3.82±1.01)and Harris hip score(67.95±5.79)were significantly different from preoperative VAS score(8.86±0.77)and hip Har? ris score(28.09±4.21)( P＜0.01).and compared with last follow?up VAS score(0.41±0.59)and hip Harris score(91.14±5.69) were significantly different(P＜0.01).Harris score system evaluation of hip joint:14 cases were cured，7 cases were markedly effec? tive，1 case was effective，the marked efficiency was 95.45%.Conclusion Biological long?stem prosthetic femoral head replace?ment for Evans type Ⅲ~Ⅳ femoral intertrochanteric fracture over 90 years old is simple and easy to operate.The patients can getout of bed early after operation to achieve good hip joint function and reduce fracture complications.The clinical effect is satisfactory. |
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