碳质涂膜人工股骨头置换修复老年股骨不稳定合并骨质疏松性骨折
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摘要
背景:老年人较易发生不稳定性合并骨质疏松性股骨骨折,临床对其进行修复治疗的过程中,可以采取不同的方案,以往大多实施内固定治疗。但目前关于老年股骨不稳定合并骨质疏松性骨折修复方法的具体选择,尚存在一定的争议。目的:观察碳质涂膜人工股骨头置换修复老年股骨不稳定合并骨质疏松性骨折的随访结果。方法:回顾性分析西安交通大学医学院附属红会医院2013年2月至2014年2月收治的83例老年股骨不稳定合并骨质疏松性骨折患者的临床资料,按照修复方法分为对照组(42例)和观察组(41例),分别实施常规内固定治疗和人工股骨头置换治疗。观察两组患者的手术所用时间、术中出血量、术后卧床时间及住院天数;随访12个月,观察两组患者的髋关节功能恢复情况以及并发症发生情况,并进行比较。结果与结论:观察组手术所用时间和术中出血情况与对照组比较差异无显著性意义(P>0.05),但观察组的术后卧床时间和住院天数均显著短于对照组(P<0.05)。观察组的治疗后髋关节功能优良率显著高于对照组,并发症发生率则显著低于对照组(P<0.05)。表明对老年股骨不稳定合并骨质疏松性骨折患者实施碳质涂膜人工股骨头置换可以获得较好的修复效果,对患者造成的损伤小,并发症少,且可以更好的改善患者的髋关节功能。
BACKGROUND: Elderly patients are more prone to unstable and osteoporotic fractures. In the clinical surgical treatment, different programs can be taken. Internal fixation was done previously. However, the precise choice of the methods of unstable and osteoporotic femoral fractures in the elderly was still controversial. OBJECTIVE: To investigate the clinical effect of carbon-coated artificial femoral head replacement in the treatment of elderly patients with unstable and osteoporotic femoral fractures. METHODS: A retrospective analysis was performed in the Honghui Hospital Affiliated to Health Science Center, Xi'an Jiaotong University from February 2013 to February 2014 in 83 cases of unstable and osteoporotic femoral fractures. These patients were divided into control group(42 cases) and observation group(41 cases) according to treatment methods. Conventional internal fixation and artificial femoral head replacement were conducted. Operation time, intraoperative blood loss, postoperative bed time and hospital stay were observed in the twogroups. Patients were followed up for 12 months. Recovery of hip function and complications were observed and compared between the two groups. RESULTS AND CONCLUSION: No significant difference in operation time and intraoperative blood loss was detected between the observation group and the control group(P > 0.05). Postoperative bed time and hospital stay were significantly shorter in the observation group than in the control group(P < 0.05). The excellent and good rate of hip joint function was significantly higher in the observation group than in the control group, but the complication rate was significantly lower in the observation group than in the control group(P < 0.05). These findings suggest that carbon-coated artificial femoral head replacement for unstable and osteoporotic femoral fractures in the elderly obtained good repair effects, had small injury to the patient and less complications. Moreover, it can better improve hip function.
BACKGROUND: Elderly patients are more prone to unstable and osteoporotic fractures. In the clinical surgical treatment, different programs can be taken. Internal fixation was done previously. However, the precise choice of the methods of unstable and osteoporotic femoral fractures in the elderly was still controversial. OBJECTIVE: To investigate the clinical effect of carbon-coated artificial femoral head replacement in the treatment of elderly patients with unstable and osteoporotic femoral fractures. METHODS: A retrospective analysis was performed in the Honghui Hospital Affiliated to Health Science Center, Xi'an Jiaotong University from February 2013 to February 2014 in 83 cases of unstable and osteoporotic femoral fractures. These patients were divided into control group(42 cases) and observation group(41 cases) according to treatment methods. Conventional internal fixation and artificial femoral head replacement were conducted. Operation time, intraoperative blood loss, postoperative bed time and hospital stay were observed in the twogroups. Patients were followed up for 12 months. Recovery of hip function and complications were observed and compared between the two groups. RESULTS AND CONCLUSION: No significant difference in operation time and intraoperative blood loss was detected between the observation group and the control group(P > 0.05). Postoperative bed time and hospital stay were significantly shorter in the observation group than in the control group(P < 0.05). The excellent and good rate of hip joint function was significantly higher in the observation group than in the control group, but the complication rate was significantly lower in the observation group than in the control group(P < 0.05). These findings suggest that carbon-coated artificial femoral head replacement for unstable and osteoporotic femoral fractures in the elderly obtained good repair effects, had small injury to the patient and less complications. Moreover, it can better improve hip function.
引文
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[2]孟昭琴.人工关节材料的仿生性能及临床应用[J].中国组织工程研究与临床康复,2010,14(22):4101-4104.
[3]洪锡伟.小切口加长柄人工股骨头置换治疗高龄股骨转子间骨折[J].中国实用医药,2010,5(17):101-103.
[4]范少地,于杰,陈戎波,等.高龄股骨转子间骨折人工关节置换的特点及假体选择[J].中国组织工程研究与临床康复,2010,14(48):9061-9064.
[5]Singh S,Kumar Jain A,Arora A.Estimation of the rate of osteogenesis by tetracycline double labeling in intertrochanteric fractures of the femur in different age groups and its correlation with radiological grading of osteoporosis.J Orthop Sci.2002;7(2):226-231.
[6]林绍仪,蔡厚洪,李春雨,等.长柄骨水泥型人工股骨头置换治疗高龄不稳定性股骨转子间骨折[J].临床骨科杂志,2011,14(2):132-134.
[7]徐兵,兰玉平,钟凤林,等.骨水泥柄双极人工股骨头置换治疗高龄股骨转子间骨折[J].西南国防医药,2013,23(6):591-593.
[8]韦树杰,覃立耿,黎勤鸿,等.骨水泥型加长柄人工双极人工股骨头置换术治疗高龄不稳定型股骨转子间骨折33例[J].广西医科大学学报,2014,31(4):655-656.
[9]汪阳,蒋林.加长柄人工双极股骨头置换术与AO股骨近端髓内钉-抗螺旋刀片内固定治疗老年不稳定型转子间骨折的疗效比较[J].中国老年学杂志,2012,32(24):5590-5591.
[10]傅要武,胡小军.长柄骨水泥型双极人工股骨头置换治疗A2高龄股骨转子间骨折30例[J].生物骨科材料与临床研究,2014,11(6):71-73.
[11]王少林,谭祖键,周明全,等.应用骨水泥型短柄假体治疗高龄股骨转子间骨折的临床研究[J].中国医师杂志,2014,16(2):243-245.
[12]俞益火,田治标,吴锦熙,等.加长柄半髋置换治疗90岁以上患者股骨转子间骨折[J].实用骨科杂志,2013,19(5):442-443.
[13]彭家全,刘春.长柄骨水泥型人工股骨头置换治疗高龄不稳定性股骨转子间骨折[J].科学咨询,2012,(1):76-77.
[14]周家强,孙明,李洪彬,等.加长柄人工股骨头置换治疗高龄股骨转子间骨折[J].天津医药,2009,37(9):806-807,819.
[15]柏文昆,鲁木,胡红耘,等.骨水泥加长柄人工股骨头置换治疗高龄不稳定性股骨转子间骨折[J].中国基层医药,2014,21(7):1004-1005.
[16]杨利斌,段永壮,杨素敏,等.长柄双动人工股骨头置换术治疗高龄不稳定性股骨转子间骨折(附30例报告)[J].山东医药,2010,50(14):46-47.
[17]袁小兵,陈岚,孙宏伟,等.碳质股骨头生物相容性的动物实验[J].中国组织工程研究与临床康复,2009,13(38):7503-7506.
[18]梁雨田,郭义柱,唐佩福,等.股骨转子重建、人工股骨头置换治疗高龄患者非稳定性股骨转子间骨折[J].中华创伤杂志,2008,24(7):524-526.
[19]高辉.人工股骨头置换对70岁以上股骨转子间骨折与股骨颈骨折患者的疗效[J].中国组织工程研究与临床康复,2008,12(35):6879-6882.
[20]O’Neill F,Mc Gloughlin T,Lenehan B.Influence of implant design on the method of failure for three implants designed for use in the treatment of intertrochanteric fractures:the dynamic hip screw(DHS),DHS blade and X-BOLT.Eur J Trauma Emer Surg.2013;39(3):249-255S.
[21]王世强,韩晓松,徐林,等.人工双动股骨头置换高龄不稳定型股骨转子间骨折40例回顾分析[J].重庆医学,2014,43(24):3230-3231,3232.
[22]冯灿林,黎霭云,梁灿荣,等.高龄重度骨质疏松症股骨转子间粉碎性骨折的手术治疗技巧与策略[J].实用医学杂志,2012,28(22):3853-3854.
[23]黄炳生,王永胜,陈顺仪,等.人工股骨头置换治疗严重股骨转子间骨折的生物力学研究[J].中国临床解剖学杂志,2012,30(6):683-686.
[24]王少林,谭祖键,周明全,等.应用生物型普通柄(短柄)假体治疗高龄股骨转子间骨折[J].中华创伤杂志,2013,29(2):127-131.
[25]梁雨田,唐佩福,郭义柱,等.90岁以上非稳定性股骨转子间骨折患者人工股骨头置换术[J].中华创伤杂志,2004,20(11):654-656.
[26]张绍伟,彭李华,赵光荣,等.人工股骨头置换治疗骨质疏松股骨转子间不稳定骨折的有限元应力分析[J].中国组织工程研究与临床康复,2011,15(35):6496-6499.
[27]Suh KT,Kang DJ,Lee JS.Bilateral intertrochanteric fractures after surgical treatment of bilateral femoral neck fractures secondary to hypocalcemic convulsions with chronic renal failure:a case report and review of the literature.Arch Orthop Trauma Surg.2006;126(2):123-126S.
[28]任云峰,张仲子,柳百炼,等.人工股骨头置换治疗高龄股骨转子间骨折疗效分析[J].医学综述,2011,17(23):3649-3651.
[29]陈戎波,范少地,胡万华,等.高龄不稳定性股骨转子间骨折的髋关节置换:先置入假体再行骨折内固定[J].中国组织工程研究与临床康复,2010,14(13):2341-2344.
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