摘要
目的:探讨人工股骨头置换术结合加速康复外科理念治疗老年不稳定股骨粗隆间骨折的疗效。方法:选择2014年6月至2015年6月应用加长柄人工股骨头置换术结合加速康复外科治疗的12例高龄不稳定股骨粗隆间骨折患者,其中左侧9例,右侧3例;年龄73～89(平均84.3)岁;男2例,女10例。按Evans-Jensen分型,Ⅲ型3例,Ⅳ型5例,Ⅴ型4例。结果:手术所用时间为55～75(平均64.5) min。术中出血150～270(平均180) mL,均未输血。术后2例彩超检查发现腓肠肌静脉栓塞,1例腔隙性脑梗死,1例伤口裂开,缝合后顺利愈合。第3天均能部分负重下床行走。使用Harris评分,术后2周平均83.5分,术后半年平均88.6分,随访时间平均16个月,优良率达89.3%,股骨粗隆间骨折愈合良好。结论:加长柄人工股骨头置术换结合加速康复外科理念治疗老年不稳定股骨粗隆间骨折是一种可供选择的良好治疗方法,但手术适应症要严格把握,并需具有熟练的手术技术。
Objective: To explore the effect of lengthened artificial femoral head replacement combined with accelerated rehabilitation surgery in the treatment of unstable intertrochanteric femoral fractures in the elderly patients. Methods: Twelve unstable intertrochanteric fractures treated with artificial femoral head replacement in combination with accelerate rehabilitation surgical treatment from June 2014 to June 2015 were enrolled in this study. There were 9 left legs and 3 right legs. Ages were 73–89(average 84.3) years;2 males and 10 females. Three cases were Evans-Jensen Ⅲ, 5 cases were Evans-Jensen Ⅳ, 4 case were Evans-Jensen Ⅴ. Results: The operation time ranged from 55 to 75 min, with an average of 64.5 min. Intraoperative blood loss was 150–270 mL(180 mL on average), and no blood transfusion was performed. Postoperative ultrasonography showed two cases of intravenous gastrocnemius embolism, 1 case of lacunar cerebral infarction, and 1 case rupture of the wound. The average Harris score was 83.5 points at 2 weeks after surgery;the average Harris score was 88.6 points at 6 months after surgery;the choiceness rate was 89.3%;the average follow-up was 16 months, and the femoral intertrochanteric fractures healed well. Conclusion: The combination of longer handle artificial femoral head set technique with accelerating rehabilitation concept of surgical in treating elderly unstable intertrochanteric fractures is an effective method, but need to master the operation indications strictly and intraoperative operating skills.
作者
李怀木
王乃集
朱铮
徐兴全
史冬泉
LI Huaimu;WANG Naiji;ZHU Zheng;XU Xingquan;SHI Dongquan(Department of Orthopedicsj Drum Tower Clinical Medical College of Nanjing Medical University,Nanjing 210008;Department of Orthopedics, Sihong County Senile Hospital,Sihong Jiangsu 223900,China)
出处
《临床与病理杂志》
2018年第11期2461-2466,共6页
Journal of Clinical and Pathological Research
关键词
加长柄
高龄
股骨粗隆间骨折
加速康复外科
lengthened stem
elderly patients
intertrochanteric fracture
enhanced recovery after surgery
