Search

人工股骨头置换术在高龄股骨粗隆间骨折中的应用

目的 总结人工股骨头置换术治疗高龄患者股骨粗隆间骨折的方法和疗效。方法 2002年2月～2005年12月，采用骨水泥型双极人工股骨头置换治疗高龄股骨粗隆间新鲜骨折19例。其中男7例，女12例；年龄78～102岁，中位年龄83.3岁。摔伤13例，车撞伤6例。损伤至手术时间2～10 d。合并糖尿病9例，高血压病9例，慢性支气管炎1例（缓解期），脑梗塞后遗症2例（骨折侧肌力在Ⅳ级以上）。术前患髋Harris评分均为差；骨折按Evan’s分型：Ⅱ型2例，Ⅲ型9例，Ⅳ型8例。结果 19例获6～41个月随访，患髋均无明显疼痛。12例恢复术前行走功能，5例行走能力下降需要扶助，2例不能独立行走。术后并发下肢深静脉血栓1例，泌尿道感染1例，一过性精神障碍2例，7例术后8~37个月分别死于心肌梗死，心衰、脑出血、肺内感染等。结论 人工股骨头置换术治疗高龄患者股骨粗隆间骨折短期疗效满意，可以显著提高患者的生活质量，但应严格掌握适应证。

Evidence-Based Treatment for an Elderly Patient with Intertrochanteric Fractures

Objective To identify an evidence-based treatment for an elderly patient with intertrochanteric fractures. Methods Clinical problems were presented on the basis of the patient’s conditions, and evidence was collected from the NGC (2000 to 2009), The Cochrane Library (Issue 4, 2009), TRIP Database, PubMed (1966 to 2009) and CBM (1978 to 2009). Treating strategies were formulated in terms of the three-combination principle (best evidence, the doctor’s professional knowledge and the patient’s desire). Results Three guidelines and sixteen studies were included. The current evidence indicated that surgery was the preferred solution to intertrochanteric fractures of the elderly patient. The sliding hip screw (SHS) appeared superior to others. There was insufficient evidence to support the routine use of closed suction drainage in orthopedic surgeries. Early surgery was associated with shorter hospital stay and improved mortality. Antibiotic prophylaxis significantly reduced infections. In order to lower the risk of venous thromboembolism, pharmacological prophylaxis should be carried out when the patient was admitted to hospital and be assisted with mechanical prophylaxis after surgery. Nutritional supplementation was conducive to the recovery of the patient. Rehabilitation ought to be performed as soon as possible. Considering the patient’s condition, the treatment option was established according to the available evidence and guidelines. Short-term follow-up showed a good outcome. Conclusion Through the evidence-based method, an individual treatment plan could obviously improve the treatment effect and prognosis.

Assessment of the Curative Effects of DHS(Dynamic Hip Screw)Plus Bone Cement in Treating Intertrochanteric Fractures in the Elderly

:目的:探讨DHS+骨水泥治疗老年股骨粗隆间骨折的疗效。方法:回顾分析2001年1月～2006年4月48例70岁以上老年股骨粗隆间骨折病例的临床资料,对其骨折类型、骨质疏松程度、合并症及临床疗效进行分析。结果:本组术后32例获得1～4年随访,无螺钉松动、髋内翻、感染或骨折延期愈合,髋关节功能评价优良率93％。结论:DHS+骨水泥治疗老年股骨粗隆间骨折具有手术时间短、创伤小、内固定牢靠、符合生物力学分配、能早期得到功能锻炼、减少术后并发症等优点;适合各种类型老年股骨粗隆间骨折的治疗。

PROGRESS ON DISTAL INTERLOCKING SCREW OF CEPHALOMEDULLARY NAIL FOR INTERTROCHANTERIC FRACTURES

ObjectiveTo summarize the progress on the distal interlocking screw of cephalomedullary nail for intertrochanteric fractures. MethodsRelated literature concerning the distal interlocking screw of cephalomedullary nail was reviewed and analyzed in terms of biomechanics, clinical application, operating difficulties, and complications. ResultsDistal interlocking screw can provide extra torsional stiffness in both short and long cephalomedullary nail. It is applied in most clinical cases. In long cephalomedullary nail, placing the distal interlocking screw increases the operative time for fixation and the amount of radiation exposure notably. In short cephalomedullary nail, placing the distal interlocking screw can cause adjacent vascular injury, stress concentration, and secondary fracture around the screw. ConclusionWhen the fracture is stable (type A1, type A2.1), it can be fixed solidly without the distal interlocking screw, but prefers to use a long nail. In unstable fracture, the distal interlocking screw should be used to prevent rotational displacement of the femur shaft and the failure of the nail.

EFFECT OF ADJUNCTIVE CANCELLOUS SCREW IN TREATMENT OF INTERTROCHANTERIC FRACTURES WITH DYNAMIC HIP SCREW FIXATION

Objective To study the technique and effect of adjunctive cancellous screw in treatment of intertrochanteric fractures with dynamic hi p screw (DHS) fixation. Methods Between April 2004 and August 2007, 33 patients with intertrochanteric fracture were treated with DHS fixation and adjunctive cancellous screw. There were 13 males and 20 females, aging 43-82 years with an average age of 67 years. Fractures were caused by traffic accident in 7 patients, by fall ing from height in 11 patients, by sprain in 15 patients. All fractures were closed. The patients were operated 3-12 days after injury. According to Evans classification, there were 12 cases of type II, 15 cases of type III, and 6 cases of type IV. Twenty-twocases had osteoporosis. Weight bear time and compl ication were recorded. Fracture heal ing and neck-shaft angle were observed on radiogram. Hip functions were evaluated using Radford criterion. Results Thirty-three patients had no intraoperative compl ications with incision heal ing by first intension. All patients were followed up from 14 months to 38 months, with an average of 21 months. Fracture heal ing was achieved within 14 weeks to 21 weeks, with an average of 17 weeks after operations. The neck-shaft angles were (134.2 ± 13.7)° 3 days after operation, (128.6 ± 8.9)° 8 weeks after operation, and (128.5 ± 9.3)° after fracture heal ing, showing no significant difference when compared with that of the third day after operation (P gt; 0.05). According to the Radford criterion at last follow-up, the excellent and good rate of hi p function was 93.9% (excellent in 21 cases, good in 10 cases, and poor in 2 cases). Compl ications such as loosening, breakage, or grievous migration of hardware were not observed. Conclusion The adjunctive cancellous screw in treatment of intertrochanteric fractures with DHS fixation can provide counteraction of tension and rotation, promote fixation stabil ity, enhance fracture heal ing and decrease compl ication.

股骨粗隆间骨折内固定术后并发股深动脉假性动脉瘤一例

目的总结1例股骨粗隆间骨折内固定术后并发股深动脉假性动脉瘤诊治体会。 方法2011年10月收治1例摔伤致右侧股骨粗隆间骨折的女性患者，年龄78岁。入院后采用股骨近端防旋髓内钉（proximal femoral nail antirotation，PFNA）行骨折复位内固定术。术后第9天出现患侧大腿疼痛并逐渐加重，血红蛋白降低。第13天B超检查示右大腿前侧包块。急诊行右下肢超选择性血管造影术，示股深动脉第2穿支远端假性动脉瘤形成。用弹簧圈行第2穿支动脉栓塞术。 结果栓塞术后患侧大腿疼痛明显减轻，肿胀逐渐消退，顺利出院。患者获随访2年，右股骨粗隆间骨折完全愈合，患侧髋关节功能Harris评分为优。 结论股骨粗隆间骨折内固定术后如出现不明原因患侧大腿疼痛、肿胀、血红蛋白进行性下降等，应警惕假性动脉瘤的发生，行选择性血管造影术明确并选择相应治疗方法。

不同方法治疗股骨粗隆间骨折

【摘 要】 目的 探讨不同方法治疗股骨粗隆间骨折的手术适应证及疗效。 方法 1999 年1 月－ 2006 年12 月，收治176 例股骨粗隆间骨折患者。男103 例，女73 例；年龄34 ～ 91 岁，平均63.5 岁。交通伤31 例，高处坠落伤11 例，跌倒伤134 例。按AO 分型：31A1 型79 例，31A2 型18 例，31A3 型7 例，31B 型15 例，32A 型34 例，32B 型12 例，32C型11 例。病程2 h ～ 7 d。35 例采用非手术治疗，83 例采用动力髋螺钉（dynamic hip screw，DHS）固定，23 例采用股骨近端髓内钉（proximal femoral nails，PFN）固定，27 例采用动力髁螺钉（dynamic condyle screw，DCS）治疗，8 例采用解剖钢板手术治疗。 结果 患者均获随访6 个月～ 7 年，平均15.2 个月。非手术治疗组3 例骨折不愈合，均放弃治疗。解剖钢板手术治疗组1 例术后10 周发生钢板断裂，予对症处理骨折愈合。余患者于术后10 ～ 15 周骨折达临床愈合。6 个月后髋关节功能根据Brumback 评价标准评定，非手术治疗者优9 例，良18 例，差8 例；DHS 手术治疗者优68 例，良12例 ，差3 例；PFN 手术治疗者优18 例，良5 例；解剖钢板手术治疗者优5 例，良1 例，差2 例；DCS 手术治疗者优15 例，良11 例，差1 例。 结论 股骨粗隆间骨折首选手术治疗，手术方案应综合考虑骨折类型、内固定器材特点以及患者病情，采取个性化的治疗方案。

股骨近端抗旋髓内钉在老年股骨粗隆间骨折治疗中的应用

目的　总结股骨近端抗旋髓内钉（PFNA）治疗老年股骨粗隆间骨折的疗效。 方法　2008年2月－2010年12月应用PFNA治疗老年股骨粗隆间骨折36例，男16例，女20例；年龄65～89岁，平均77.2岁。致伤原因：摔伤29例，交通事故伤7例。左侧27例，右侧9例。骨折按AO分型：31-A1型6例，31-A2型22例，31-A3型8例。受伤至手术时间3～12 d，平均5 d。 结果　治疗后30例获随访，随访时间7～18个月，平均9个月，骨折全部愈合，愈合时间12～19周，平均14周。术后Harris髋关节功能评分：优23例，良6例，差1例，优良率 96.7%。 结论　PFNA 治疗老年股骨粗隆间骨折是一种理想方法。

动力髋螺钉在股骨粗隆间骨折的应用

PRELIMINARY CLINICAL EFFECT OF PROXIMAL FEMORAL NAIL ANTI-ROTATION TO TREAT FEMORALINTERTROCHANTERIC FRACTURES

Objective To evaluate the primary cl inical effect of proximal femoral nail anti-rotation (PFNAR) in treating femoral intertrochanteric fractures, to summarize operation skills and to analyze correlated curative effective influentialfactors. Methods From July 2006 to May 2007, 19 cases of intertrochanteric fractures (including 8 males, 11 females, aged45-87 years old) were treated with closed reduction and PFNAR fixation. Fractures were caused by fall ing. The locations were left sides in 10 cases and right sides in 9 cases. According to AO classification, there were 14 cases of type A2 and 5 cases of type A3. Operative time, volume of blood loss and weight bear time were analyzed, the condition of fracture union was observed and the hip function was evaluated using Harris criterion after 9 months of follow-up. Results Operative time ranged 23-78 minutes with an average time of 47 minutes, the volume of blood loss ranged 50-120 mL with an average volume of 85 mL, getting-outof- bed time ranged 2-14 days with an average time of 7.4 days; the weight bearing time ranged 10-14 weeks with an average time of 12.4 weeks. No intra-operative femoral fractures and no regional or deep infection occurred during hospital ization period. Seventeen cases were followed up from 3 months to 12 months with an average time of 9.4 months, and achieved bone heal ing within 15-18 weeks with an average time of 16.5 weeks. No compl ications such as delay heal ing, coxa vara or coxa valga, cut-out and screw extraction occurred. Fifteen cases were followed up over 9 months; according to the Harris criterion for evaluation, the results were excellent in 13 cases, good in 1 case and fair in 1 case, the excellent and good rate was 93.3%. Conclusion PFNAR has the advantages of micro invasion, easy-to-perform, less blood loss, less bone loss and stable fixation in treatment of unstable comminuted intertrochanteric fracture, especially in old patients with osteoporosis.