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经股骨大粗隆后方骨折块入路行人工股骨头置换术治疗老年股骨粗隆间骨折 被引量:6

Treatment of femoral intertrochanteric fractures in elderly patients with artificial femoral head replacement by posterior fractured approach of femur greater trochanter
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摘要 目的比较采用传统后外侧入路和经股骨大粗隆后方骨折块入路2种入路方式行人工股骨头置换术治疗老年股骨粗隆间骨折的疗效。方法笔者自2010-02—2014-02采用人工股骨头置换术治疗111例老年股骨粗隆间骨折,26例伴有股骨大粗隆后方骨折块均采用经股骨大粗隆后方骨折块入路行人工股骨头置换术,并将骨折块用克氏针张力带固定(A组);其余85例均采用传统的后外侧入路行工股骨头置换术(B组)。观察比较2组切口长度、手术时间、术中出血量、术后引流量、输血率、住院时间、股骨头脱位率等。结果 2组均获得随访平均12(11~13)个月,2组在切口长度、手术时间、输血率、住院时间方面比较差异无统计学意义(P>0.05)。A组在术中出血量、术后引流量方面均明显低于B组,术后3、6个月髋关节功能Harris评分明显高于B组,差异均有统计学意义(P<0.05)。A组术后股骨头脱位率低于B组,但差异无统计学意义(P>0.05)。结论经股骨大粗隆后方骨折块入路行人工股骨头置换术不切断外旋肌群,不切除关节囊,术后髋关节稳定性好,远近期髋关节功能恢复良好,术后并发症发生率低,对于合并后方骨折块的股骨粗隆间骨折行人工股骨头置换是一种较为理想的入路。 Objective To compare the clinical efficacy of the traditional posterolateral approach and the posterior greater trochanter of femur fractUre approach in the treatment of femoral intertrochanteric fracture in the elderly patients with artificial femoral head replacement. Methods One hundred and eleven patients with femoral intertrochanterie fractures were treated by artificial femoral head replacement from February" 2010 to February 2014. Twenty six patients with femoral trochanterie fracture were treated by the posterior greater trochanter of femur fracture approach with artificial femoral head replacement and Kirsehner wire tension band (group A); 85 patients underwent the traditional posterolateral approach for artificial femoral head replacement (group B). The incision length, operation time, intraoperative blood loss, postoperative blood flow, blood transfusion rate, hospitalization time and the rate of femoral head dislocation were observed and compared between the 2 groups. Results The 2 groups were followed up for an average of 12 (from 11 to 13) months. There was no significant difference in incision length, operation time, blood transfusion rate and hospitalization time between the 2 groups (P 〉0.05). The intraoperative blood loss and postoperative blood flow in group A were significantly lower than those in group B respectively (P 〈0.05), while the hip joint function Harris score of 3 and 6 months after surgery were significantly higher than those of group B respectively(P 〈0.05). The rate of femoral head dislocation of group A was lower than that of group B, without statistically significant (P 〉0.05). Conclusion The artificial femoral head replacement with the approach of posterior greater trochanter of femur fracture does not cut off the external rotator muscle group or resects joint capsule; and this method can hold postoperative hip stability, hip joint function with good recovery, low incidence of postoperative complications. It is an ideal approach to artific
作者 王飞 郝申申 刘志斌 WANG Fei HAO Shen-shen LIU Zhi-bin(Department of Orthopaedics, Affiliated Hospital of Yan 'an University, Yan'an, Shaanxi 716000, China)
出处 《中国骨与关节损伤杂志》 2017年第10期1026-1028,共3页 Chinese Journal of Bone and Joint Injury
关键词 股骨粗隆间骨折 手术入路 人工股骨头置换术 Femoral intertrochanteric fracture Surgical approach Artificial femoral head replacement
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