摘要
[目的]介绍组合微创半髋置换术治疗老年股骨粗隆间骨折的手术技术与初步临床效果。[方法]对1例95岁右股骨转子间粉碎性骨折患者行上述手术治疗。患者取侧卧位,行右髋上方切口,经肌间隙显露梨状肌窝、股骨颈上壁和股骨头边缘部分。在梨状窝开髓,置入股骨髓腔铰刀,依次行股骨扩髓。关节囊内行股骨颈高位两刀楔形截骨,先取出楔形骨块,再用取头器取出股骨头。将双动股骨头假体先置入髋臼内,再置入股骨柄假体,将特制的大转子内侧微型锁定钢板用螺钉连接固定到假体上端后,用螺钉固定大转子骨折块。将股骨柄假体与双动头假体复位。[结果]患者手术顺利,无术中并发症,手术时间50 min,切口长度6 cm,术中失血量50 ml,术后3 h即在床上主动屈髋和外展功能训练,次日下地部分负重,2周能室内弃拐行走,1个月时能持手杖轻松户外散步。[结论]此技术可以经肌间隙小切口同时完成HA假体的置入和粗隆间骨折固定,具有创伤小、出血少、术中无需牵引床和更少术中透视等优点。术后稳定性好、允许早期负重行走和大范围活动。
[Objective] To introduce the surgical techniques and preliminary clinical results of combined minimally invasive hemiarthroplasty(HA) of the hip for intertrochanteric fractures in the elderly. [Methods] A 95-year-old female received abovementioned surgical treatment for comminuted intertrochanteric fracture of the right femur. The patient was placed in lateral decubitus and a small incision was made superior to the right hip to expose the piriformis fossa, superior aspect of the femoral neck, and margin of the femoral head. After opening the medullary cavity at the piriform fossa, the femoral reamer was placed into the cavity for reamming in seral. A wedge osteotomy was conducted on the femoral neck with two cuts within the capsule, the wedge bone block was removed firstly, followed by remove of the femoral head. After the bipolar heed component was place into the acetabulum, the femoral stem was inserted with a specific-designed mini plate attached with it. As the stem was pushed in place, the greater trochanter fracture was fixed by screw with the plate. Finally, the femoral stem was reduced into the bipolar femoral head component. [Results] The patient was successfully operated without intraoperative complications, whereas with operation time of 50 min, incision length of 6 cm, and intraoperative blood loss of 50 ml. The patient resumed active hip activity including active hip flexion and abductive function training in bed 3 hours after the operation, ambulation the next day, and walking easily out room 1 month later. [Conclusion] This novel technique permits placement of HA prosthesis and fixation of the intertrochanteric fracture in the same stage through the small incision. It takes the advantages of reducing iatrogenic trauma, intraoperative bleeding and fluoroscopy without traction table, as well as achieving good postoperative stability to allow early weight-bearing walking and wide range of motion.
作者
夏冰
张永华
刘振鹏
毛辉飞
巫国军
XIA Bing;ZHANG Yong-hua;LIU Zhen-peng;MAO Hui-fei;WU Guo-jun(Department of Orthopedics,Zhejiang Provincial People's Hospital,Hangzhou 310014,China;Department of Joint Surgery,Zhejiang Orthopedics Hospital,Hangzhou 310025,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2022年第14期1303-1306,共4页
Orthopedic Journal of China
基金
浙江省中医药科技计划科研基金项目(编号:2021ZA117)
浙江省医药卫生科技计划面上项目(编号:2021KY957)
合作研究提升计划项目(编号:2020xkjT040)。
关键词
老年人
骨质疏松
微创手术
半髋置换
elderly
osteoporosis
minimally invasive surgery
hemiarthroplasty of the hip
