摘要
背景:人工股骨头置换是治疗高龄不稳定性股骨转子间骨折的有效方法,但是对于Evans-Ⅲ型股骨转子间骨折,人工股骨头置换术中同期行小转子重建与否对治疗效果的影响未见报道。目的:分析小转子重建对高龄Evans-Ⅲ型股骨转子间骨折患者长柄人工股骨头置换治疗效果的影响。方法:回顾性分析西安交通大学第二附属医院骨关节外科2017年6月至2021年5月因Evans-Ⅲ型股骨转子间骨折行双极长柄人工股骨头置换的45例高龄患者的病历资料,根据术中小转子是否重建(复位并固定)分为2组,小转子重建组25例,小转子非重建组20例。比较两组患者的手术时间、出血量、下床时间、住院时间、术后3,6个月的Harris评分以及随访期内的并发症发生情况。结果与结论:①小转子重建组需要的手术时间(99.72±13.41)min较非重建组(88.90±16.53)min更长(t=2.369,P=0.023),二者在出血量、下床时间和住院时间方面差异无显著性意义(P>0.05);②术后3个月时,重建组的Harris评分(69.06±5.64)分高于非重建组(63.35±5.93)分(t=2.982,P=0.005);术后6个月时,重建组的Harris评分(86.67±4.49)分也高于非重建组(82.34±5.68)分(t=2.782,P=0.009);③此外重建组和非重建组在随访期内的并发症发生率未见显著差异(χ2=0.008,P=0.927);④提示对于高龄Evans-Ⅲ型股骨转子间骨折患者,在人工股骨头置换过程中行小转子重建虽然延长了手术时间,但是明显改善了患者术后早期的髋关节功能,初步说明小转子重建在高龄Evans-Ⅲ型转子间骨折人工股骨头置换过程中的重要性。
BACKGROUND:Artificial femoral head replacement is an effective method for the treatment of elderly unstable intertrochanteric fractures.However,the effect of lesser trochanter reconstruction in femoral head replacement for Evans-III femoral intertrochanteric fractures has not been reported.OBJECTIVE:To analyze the effect of lesser trochanter reconstruction on the outcome of artificial femoral head replacement with long stem in elderly patients with Evans-III femoral intertrochanteric fracture.METHODS:A retrospective analysis was performed on medical records of 45 elderly patients who underwent bipolar long-stem artificial femoral head replacement due to Evans-III femoral intertrochanteric fractures in the Department of Bone and Joint Surgery,Second Affiliated Hospital of Xi’an Jiaotong University from June 2017 to May 2021.According to whether the small trochanter was reconstructed during surgery(reduction and fixation),they were divided into the reconstruction group(n=25)and the non-reconstruction group(n=20).The operation time,bleeding volume,time of getting out of bed,hospital stay time,Harris scores at 3 and 6 months postoperatively,and the incidence of complications during follow-up were compared between the two groups.RESULTS AND CONCLUSION:(1)The operation time of the reconstruction group was longer(99.72±13.41 minutes)than that of the non-reconstruction group(88.90±16.53 minutes)(t=2.369,P=0.023),and there were no significant differences in bleeding volume,time of getting out of bed or hospital stay time between the two groups(P>0.05).(2)The Harris score of the reconstruction group(69.06±5.64 points)was higher than that of the non-reconstruction group(63.35±5.93 points)at 3 months postoperatively(t=2.982,P=0.005).At 6 months postoperatively,the Harris score of the reconstruction group(86.67±4.49 points)was higher than that of the non-reconstruction group(82.34±5.68 points)(t=2.782,P=0.009).(3)In addition,no significant difference existed in the incidence�of�complications�between�the�reconstruction�and�non-reconstruction�groups�(χ2=0.008,P=0.927).(4)It is concluded that in elderly patients with Evans-III femoral intertrochanteric fractures,lesser trochanter reconstruction in the artificial femoral head replacement significantly improved postoperative hip function despite increased operative time,demonstrating the importance of the lesser trochanter reconstruction in the artificial femoral head replacement for Evans-III intertrochanteric fractures in the elderly people.
作者
马瑞
葛莹
王坤正
杨佩
Ma Rui;Ge Ying;Wang Kunzheng;Yang Pei(Department of Bone and Joint Surgery,Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,Shaanxi Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2024年第12期1880-1884,共5页
Chinese Journal of Tissue Engineering Research
关键词
人工股骨头置换
小转子重建
不稳定性股骨转子间骨折
股骨近端重建
髋关节功能
artificial femoral head replacement
lesser trochanter reconstruction
unstable femoral intertrochanteric fracture
proximal femur reconstruction
hip function
