生物型加长柄髋关节置换治疗老年不稳定性转子间骨折中股骨近端不同重建方法的疗效对比
|
摘要
背景:老年不稳定性转子间骨折通过生物型加长柄髋关节置换治疗,需对股骨近端重要结构进行重建,但对于重建的方法未达成共识。目的:比较生物型加长柄髋关节置换治疗老年不稳定性转子间骨折过程中股骨近端不同重建方法的临床疗效。方法:回顾性分析2015年3月至2017年4月重庆市中医骨科医院收治的52例生物型加长柄髋关节置换治疗老年不稳定性转子间骨折患者,所有患者按照Evans分型均为Ⅲ、Ⅳ、Ⅴ型,双光子骨密度仪测定腰椎骨密度T值<-2.5。根据股骨近端重建方法分为2组,A组25例采用克氏针张力带钢丝捆绑重建股骨近端,B组27例采用钢丝加不可吸收缝合线捆绑重建股骨近端。比较2组手术时间、术中出血量、切口长度、独立负重时间、术后并发症以及术后1个月、3个月、6个月、1年的Harris评分。结果与结论:(1)A组手术时间、术后出血量多于B组(P <0.01);(2)2组切口长度、独立负重时间差异无显著性意义(P> 0.05);(3)A组术后并发症发生率高于B组,差异有显著性意义(P <0.05);(4)2组术后1个月、3个月、6个月、1年的Harris髋关节功能评分相比,差异无显著性意义(P> 0.05);(5)提示生物型加长柄髋关节置换治疗老年不稳定性转子间骨折术中采用钢丝加不可吸收缝合线固定股骨近端,可明显缩短手术时间、减少术中出血量、降低术后并发症。
BACKGROUND: Treatment of unstable intertrochanteric fractures in the elderly by cementless long-stem hip arthroplasty requires the reconstruction of the important structure of proximal femur, but the reconstruction methods remain controversial. OBJECTIVE: To compare the clinical efficacy of proximal femur reconstruction using different methods in cementless long-stem hip arthroplasty for senile unstable femoral intertrochanteric fractures. METHODS: A retrospective study of 52 older adults with unstable femoral intertrochanteric fractures undergoing cementless long-stem hip arthroplasty at Chongqing Orthopedic Hospital of Traditional Chinese Medicine from March 2015 to April 2017 was conducted. All patients belonged to types III, IV, and V according to Evans classification, and bone mineral density of lumbar spine T value was less than-2.5. The patients were divided into groups A(n=25, fixed by Kirschner wire and tension band wearing) and B(n=27, fixed by steel wire and non-absorbable suture). The operation duration, intraoperative blood loss, incision length, independent weight-bearing time, postoperative complications and Harris scores at 1, 3, 6 and 12 months postoperatively were compared. RESULTS AND CONCLUSION:(1) The operation time and intraoperative blood loss in the group A were significantly higher than those in the group B(P < 0.01).(2) There was no significant difference in the incision length or postoperative independent weight-bearing time between two groups(P > 0.05).(3) The incidence of postoperative complications in the group A was significantly higher than that in the group B(P < 0.05).(4) The Harris hip scores at 1, 3, 6 and 12 months showed no significant differences between two groups(P > 0.05).(5) In summary, steel wire and non-absorbable suture applied in the cementless long-stem hip arthroplasty for senile unstable femoral intertrochanteric fractures can significantly shorten the operation time, reduce intraoperative blood loss and decrease the postoperative complications.
BACKGROUND: Treatment of unstable intertrochanteric fractures in the elderly by cementless long-stem hip arthroplasty requires the reconstruction of the important structure of proximal femur, but the reconstruction methods remain controversial. OBJECTIVE: To compare the clinical efficacy of proximal femur reconstruction using different methods in cementless long-stem hip arthroplasty for senile unstable femoral intertrochanteric fractures. METHODS: A retrospective study of 52 older adults with unstable femoral intertrochanteric fractures undergoing cementless long-stem hip arthroplasty at Chongqing Orthopedic Hospital of Traditional Chinese Medicine from March 2015 to April 2017 was conducted. All patients belonged to types III, IV, and V according to Evans classification, and bone mineral density of lumbar spine T value was less than-2.5. The patients were divided into groups A(n=25, fixed by Kirschner wire and tension band wearing) and B(n=27, fixed by steel wire and non-absorbable suture). The operation duration, intraoperative blood loss, incision length, independent weight-bearing time, postoperative complications and Harris scores at 1, 3, 6 and 12 months postoperatively were compared. RESULTS AND CONCLUSION:(1) The operation time and intraoperative blood loss in the group A were significantly higher than those in the group B(P < 0.01).(2) There was no significant difference in the incision length or postoperative independent weight-bearing time between two groups(P > 0.05).(3) The incidence of postoperative complications in the group A was significantly higher than that in the group B(P < 0.05).(4) The Harris hip scores at 1, 3, 6 and 12 months showed no significant differences between two groups(P > 0.05).(5) In summary, steel wire and non-absorbable suture applied in the cementless long-stem hip arthroplasty for senile unstable femoral intertrochanteric fractures can significantly shorten the operation time, reduce intraoperative blood loss and decrease the postoperative complications.
引文
[1]叶少腾,陈凯宁,蓝创新,等.半髋置换在高龄不稳定型股骨转子间骨折治疗中的价值[J].临床和实验医学杂志,2013,12(8):574-576.
[2]陈雁西,强敏菲.股骨转子间骨折的治疗策略与数字化临床路径[J].中华骨科杂志,2017,37(17):1111-1117.
[3]Kim JY,Kong GM.Subcapital femoral neck fracture after treatment of an intertrochanteric fracture with proximal femoral intramedully nail.Coll Physicians Surg Pak.2016;26(1):78-79.
[4]卢晓,罗斌.双极股骨头半髋置换与股骨近端防旋髓内钉固定治疗老年非稳定股骨粗隆间骨折的疗效比较研究[J].浙江创伤外科,2018,23(1):89-91.
[5]汤宇宏,赵丹红.人工股骨头置换与动力髋螺钉治疗高龄股骨粗隆间骨折的疗效比较[J].浙江创伤外科,2015,20(6):1227-1228.
[6]徐风瑞,何明武,姚忠军,等.PFNA内固定与人工股骨头置换术治疗高龄骨质疏松性股骨粗隆间骨折的比较[J].中国骨与关节损伤杂志,2016,31(2):130-133.
[7]董建彬,王智勇,芦浩,等.内固定术与髋关节置换术治疗股骨粗隆间骨折疗效的Meta分析[J].中国骨伤,2015,28(3):245-251.
[8]Makinen TJ,Gunton M,Fichman SG,et al.Arthroplasty for pertrochanterie hip fractures.Orthop Clin North Am.2015;46(4):433-444.
[9]Vermesan D,Prejbeanu R,Poenaru DV,et al.Do intramedullary implants improve survival in elderly patients with trochanteric fractures?A retrospective study.Clin Ter.2015;166(3):e140-e145.
[10]赵卓,周学颖,张艳秋,等.高分子体位垫在双髋关节置换术中应用价值的研究[J].中国实验诊断学,2015,6(4):667-668.
[11]张飞,彭吾训.髋关节置换术在治疗老年股骨转子间骨折中的应用现状[J].实用医学杂志,2016,32(21):3486-3488.
[12]Tomonori B,Katsuo S,Kazuo K.Bipolar hemiarthroplasty for femoral neck fracture using the direct anterior approach.World J Orthop.2013;4(2):85-89.
[13]Colais P,Pinnarelli L,Fusco D,et al.The impact of a pay for performance system on timing to hip fracture surgery:experience from the Lazio Region(Italy).BMC Health Serv Res.2013;13(1):393.
[14]姚绍平,孙先润,李维朝,等.不稳定型股骨转子间骨折人工股骨头置换和股骨近端髓内钉内固定疗效分析[J].创伤骨科杂志,2015,17(2):131-133.
[15]张殿英,姜保国,付中国.防旋股骨近端髓内钉治疗转子间骨折的初步疗效分析[J].中华创伤杂志,2007,23(2):91-93.
[16]Kiran Kumar GN,Meena S,Vijaya Kumar N,et al.Bipolar hemiarthroplasty in unstable intertrochanteric fractures in elderly:a prospective study.J Clin Diagn Res.2013;7(8):1669-1671.
[17]黄晓微,禹宝庆,李泽湘,等.动力髋螺钉和Gamma钉置入固定不稳定股骨转子间骨折的三维有限元分析[J].中国组织工程研究,2015,19(53):8603-8608.
[18]王加刚,沈鹏程,朱立帆,等.三种治疗老年股骨转子间骨折内固定法的临床疗效对比研究[J].实用骨科杂志,2017,23(11):1032-1035.
[19]刘潮坚,蔡拉加,石昭宏,等.半髋置换加钢丝环扎术在高龄不稳定粗隆间骨折的应用[J].创伤外科杂志,2016,18(5):281-283.
[20]唐佩福,王岩,卢世璧,等.坎贝尔骨科手术学[M].13版.北京:北京大学出版社,2018:2648.
[21]袁志,毕龙.老年股骨转子间骨折的治疗趋势[J].中华骨科杂志,2017,37(17):1057-1060.
[22]陈剑虹,李顺东,童培建,等.人工股骨头置换术与股骨近端防旋髓内钉治疗高龄股骨转子间骨折的对比研究[J].中国中医骨伤科杂志,2016,24(2):18-28.
[23]Cui Q,Liu YS,Li DF,et al.Cemented hip hemiarthroplasty clinical observations on unstable intertrochanteric fracture in elderlies.Eur J Trauma Emerg Surg.2016;42:651-656.
[24]吕荷荣,项少梅,王艮存,等.老年股骨颈及股骨粗隆间骨折治疗方法的选择[J].中国骨与关节损伤杂志,2015,3(6):628-629.
[25]冯暘,陈斌,张焱,等.半髋置换与股骨近端防旋髓内钉治疗股骨粗隆间骨折的比较[J].中国矫形外科杂志,2017,25(12):1081-1085.
[26]张兵.不同方案治疗老年严重骨质疏松股骨转子间骨折的疗效和安全性的对比[J].检验医学与临床,2014,11(16):2222-2225.
[27]陈述祥,刘彦,陈丽君.老年股骨转子间骨折不同治疗方法的评价[J].暨南大学学报,2014,35(2):178-181.
[28]Shi H,Xiao L,Wang Z.Curative effect of artificial femoral head replacement and its effect on hip joint function and complications of senile patients with femoral intertrochanteric fracture.Exp Ther Med.2018;16(2):623-628.
[29]汪洋,彭家全,唐春江.防旋转股骨近端髓内钉与人工关节置换治疗老年股骨转子间骨折的比较[J].重庆医学,2017,6(2):2706-2707.
[30]王建年.双极股骨头半髋置换治疗老年不稳定粗隆间骨折的疗效及预后影响因素[J].实用临床医药杂志,2016,20(11):116-117.
[31]Zhao R,Cai H,Liu Y,et al.Risk factors for intraoperative proximal femoral fracture during primary cementless THA.Orthopedics.2017;40(2):e821-e287.
[32]谢庆云,张波,权毅,等.人工双极股骨头置换中大转子不同固定方法的比较[J].中国组织工程研究及临床康复,2011,15(26):4781-4784.
[33]Sancheti KH,Sancheti P,Shyam A,et al.Primary hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in the elderly:A retrospective case series.Indian JOrthop.2010;44(4):428-434.
[2]陈雁西,强敏菲.股骨转子间骨折的治疗策略与数字化临床路径[J].中华骨科杂志,2017,37(17):1111-1117.
[3]Kim JY,Kong GM.Subcapital femoral neck fracture after treatment of an intertrochanteric fracture with proximal femoral intramedully nail.Coll Physicians Surg Pak.2016;26(1):78-79.
[4]卢晓,罗斌.双极股骨头半髋置换与股骨近端防旋髓内钉固定治疗老年非稳定股骨粗隆间骨折的疗效比较研究[J].浙江创伤外科,2018,23(1):89-91.
[5]汤宇宏,赵丹红.人工股骨头置换与动力髋螺钉治疗高龄股骨粗隆间骨折的疗效比较[J].浙江创伤外科,2015,20(6):1227-1228.
[6]徐风瑞,何明武,姚忠军,等.PFNA内固定与人工股骨头置换术治疗高龄骨质疏松性股骨粗隆间骨折的比较[J].中国骨与关节损伤杂志,2016,31(2):130-133.
[7]董建彬,王智勇,芦浩,等.内固定术与髋关节置换术治疗股骨粗隆间骨折疗效的Meta分析[J].中国骨伤,2015,28(3):245-251.
[8]Makinen TJ,Gunton M,Fichman SG,et al.Arthroplasty for pertrochanterie hip fractures.Orthop Clin North Am.2015;46(4):433-444.
[9]Vermesan D,Prejbeanu R,Poenaru DV,et al.Do intramedullary implants improve survival in elderly patients with trochanteric fractures?A retrospective study.Clin Ter.2015;166(3):e140-e145.
[10]赵卓,周学颖,张艳秋,等.高分子体位垫在双髋关节置换术中应用价值的研究[J].中国实验诊断学,2015,6(4):667-668.
[11]张飞,彭吾训.髋关节置换术在治疗老年股骨转子间骨折中的应用现状[J].实用医学杂志,2016,32(21):3486-3488.
[12]Tomonori B,Katsuo S,Kazuo K.Bipolar hemiarthroplasty for femoral neck fracture using the direct anterior approach.World J Orthop.2013;4(2):85-89.
[13]Colais P,Pinnarelli L,Fusco D,et al.The impact of a pay for performance system on timing to hip fracture surgery:experience from the Lazio Region(Italy).BMC Health Serv Res.2013;13(1):393.
[14]姚绍平,孙先润,李维朝,等.不稳定型股骨转子间骨折人工股骨头置换和股骨近端髓内钉内固定疗效分析[J].创伤骨科杂志,2015,17(2):131-133.
[15]张殿英,姜保国,付中国.防旋股骨近端髓内钉治疗转子间骨折的初步疗效分析[J].中华创伤杂志,2007,23(2):91-93.
[16]Kiran Kumar GN,Meena S,Vijaya Kumar N,et al.Bipolar hemiarthroplasty in unstable intertrochanteric fractures in elderly:a prospective study.J Clin Diagn Res.2013;7(8):1669-1671.
[17]黄晓微,禹宝庆,李泽湘,等.动力髋螺钉和Gamma钉置入固定不稳定股骨转子间骨折的三维有限元分析[J].中国组织工程研究,2015,19(53):8603-8608.
[18]王加刚,沈鹏程,朱立帆,等.三种治疗老年股骨转子间骨折内固定法的临床疗效对比研究[J].实用骨科杂志,2017,23(11):1032-1035.
[19]刘潮坚,蔡拉加,石昭宏,等.半髋置换加钢丝环扎术在高龄不稳定粗隆间骨折的应用[J].创伤外科杂志,2016,18(5):281-283.
[20]唐佩福,王岩,卢世璧,等.坎贝尔骨科手术学[M].13版.北京:北京大学出版社,2018:2648.
[21]袁志,毕龙.老年股骨转子间骨折的治疗趋势[J].中华骨科杂志,2017,37(17):1057-1060.
[22]陈剑虹,李顺东,童培建,等.人工股骨头置换术与股骨近端防旋髓内钉治疗高龄股骨转子间骨折的对比研究[J].中国中医骨伤科杂志,2016,24(2):18-28.
[23]Cui Q,Liu YS,Li DF,et al.Cemented hip hemiarthroplasty clinical observations on unstable intertrochanteric fracture in elderlies.Eur J Trauma Emerg Surg.2016;42:651-656.
[24]吕荷荣,项少梅,王艮存,等.老年股骨颈及股骨粗隆间骨折治疗方法的选择[J].中国骨与关节损伤杂志,2015,3(6):628-629.
[25]冯暘,陈斌,张焱,等.半髋置换与股骨近端防旋髓内钉治疗股骨粗隆间骨折的比较[J].中国矫形外科杂志,2017,25(12):1081-1085.
[26]张兵.不同方案治疗老年严重骨质疏松股骨转子间骨折的疗效和安全性的对比[J].检验医学与临床,2014,11(16):2222-2225.
[27]陈述祥,刘彦,陈丽君.老年股骨转子间骨折不同治疗方法的评价[J].暨南大学学报,2014,35(2):178-181.
[28]Shi H,Xiao L,Wang Z.Curative effect of artificial femoral head replacement and its effect on hip joint function and complications of senile patients with femoral intertrochanteric fracture.Exp Ther Med.2018;16(2):623-628.
[29]汪洋,彭家全,唐春江.防旋转股骨近端髓内钉与人工关节置换治疗老年股骨转子间骨折的比较[J].重庆医学,2017,6(2):2706-2707.
[30]王建年.双极股骨头半髋置换治疗老年不稳定粗隆间骨折的疗效及预后影响因素[J].实用临床医药杂志,2016,20(11):116-117.
[31]Zhao R,Cai H,Liu Y,et al.Risk factors for intraoperative proximal femoral fracture during primary cementless THA.Orthopedics.2017;40(2):e821-e287.
[32]谢庆云,张波,权毅,等.人工双极股骨头置换中大转子不同固定方法的比较[J].中国组织工程研究及临床康复,2011,15(26):4781-4784.
[33]Sancheti KH,Sancheti P,Shyam A,et al.Primary hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in the elderly:A retrospective case series.Indian JOrthop.2010;44(4):428-434.