小切口骨水泥双极人工股骨头置换治疗老年移位股骨颈骨折临床分析(1)
【摘要】 目的 观察小切口骨水泥双极人工半髋关节置换治疗老年移位股骨颈骨折的临床疗效,为临床选择更为合理的假体构型。方法 在2004年6月至2008年12月间,应用骨水泥双极人工股骨头置换治疗老年(年龄67~89岁)移位股骨颈骨折67例,Garden分型:III型56例,IV型11例。取髋前外侧(改良Hardinge切口)手术入路,平均手术时间约45 min,常规输血200 ml。术后加强对患肢活动和负重情况的监察及指导。结果 随访15~85个月,平均38个月。根据改良Harris评分系统,术后36个月平均为92分,60个月为89分,无髋关节脱位及明显髋股部疼痛病例。结论 小切口骨水泥双极人工股骨头置换术符合老年的骨质特点,初始稳定性良好。手术时间短,创伤和风险小,术后中短期并发症发生率低,不失为一种治疗老年股骨颈骨折的良好疗法。
【关键词】股骨颈骨折; 老年; 骨水泥; 双极; 半关节置换术
Small Incision Cement Bipolar Hemiarthroplasty for Displacsd Femoral Neck Fracture in the Elderly
, 百拇医药
CHEN Xi lu,ZHUANG Ming tuo,WU Wei hua,et al.XiaShan Orthopedics and Traumatology Hospital of Zhanjiang,Guangdong 524003,China
【Abstract】 Objective To observe the clinic effect of cement bipolar hemi arthroplasty for displacsd femoral neck fracture in the elderly,and choose more rational configuration of prosthesis for clinic.Methods From Jun.2004 to Dec.2008.67 elderly patients(Age 67 89 years old)with displaced femoral neck fracture were operated by the cement bipolar hemiarthroplasty.
, 百拇医药
There were 56 patients in Garden Types Ⅲand 11 patients in Garden Types.All expose the fracture through the Hardinge incision.The mean operating time was 45 minutes and routine transfuse 200 ml.Activity and loading status were supervised and emphasized after the operation.Results Follow up for 15 to 86 months(mean 38 months).According to Modified Harris’scoring system,the average score was postoperative 36 months 92,60 months 89.There was no case of hip dislocation or pain of hip and thigh obviously.Conclusion The hip hemiarthroplasty is consistent with the sclerotin feature of old age and the incipient stability is good.The operating time is short,the trauma and risk is little.The complication incidence rate of the short and mediate time is low after operation.It can still be considered a good therapy well to displacsd femoral neck fracture in the elderly.
, http://www.100md.com
【Key words】Femoral neck fracture; Elderly; Cement; Bipolar; Hemiarthroplasty
股骨颈骨折是老年人的常见骨折之一,随着社会的老龄化其发生率呈逐渐上升趋势。骨折后的骨不愈合和股骨头缺血性坏死仍是目前治疗上的棘手问题,因而寻求理想的治疗方法仍是骨科临床研究的焦点。除无移位型骨折可行确切有效的内固定治疗外,人工髋关节置换是近年骨科学术界的共识。股骨颈骨折的手术方案选择,仍是一个没有完全解决的问题。在2004年6月至2008年12月间,我们立足于生物力学的基础上,应用小切口骨水泥人工双极股骨头置换治疗老年移位股骨颈骨折67例,取得良好的治疗效果。报告如下。
1 临床资料
本组67例,其中:男28例,女39例;年龄67~89岁,平均72.3岁。骨折类型;头下型43例,颈中型21例,基底型3例。Garden分型:III型56例,IV型11例。其中术前患有高血压病16例,冠心病13例,糖尿病7例,脑梗死治愈后4例。
, 百拇医药
2 治疗方法
住院后常规皮牵制动止痛,手术当天应用抗生素至术后1周防止感染。持续硬外麻下进行手术。取患髋前外侧入路(改良Hardinge切口)[1],长约10 cm。分层切开皮肤、皮下和阔筋膜张肌筋膜,沿肌纤维方向部分切开臀大肌,显露股骨大粗隆和臀中肌,于大粗隆尖端前缘骨膜下剥离臀中肌止点的前1/3,L型切开臀小肌肌腱,将髋屈曲、内收和外旋,必要时亦可切断股直肌的反折头使术野尽可能向前下方扩大,十字切开关节囊,取出股骨头。股骨残端截骨面与股骨干成45°并与股骨颈轴线垂直,保留1.0~1.5 cm的股骨距。切除圆韧带。用假体柄试件扩大股骨髓腔,注意保持10~15°的前倾角,选取相应匹配的骨水泥型假体柄试行置入适宜后拔出,高压冲洗骨髓残腔及清洗术野。将骨水泥塞子置入髓腔,然后用骨水泥枪注入骨水泥并打入假体柄。骨水泥结固后套上与患者股骨头直径相同的双极假体头。牵引复位髋关节,试行各方向活动稳定,再次冲洗术野并常规注入适量抗生素液,修补缝合关节囊、臀小肌和臀中肌止点,放置负压引流管并分层缝合切口。手术耗时约40 min,输血200 ml。术后皮牵制动1周并置患肢于外展中立位,24~48 h拔除引流管。3周后逐步扶拐负重练习行走。
3 治疗结果
随访15~86个月,平均38个月。术后2例出现患侧下肢肿胀(均为左侧),拟诊为下肢深静脉血栓形成,经过抬高患肢并加强肌肉的舒缩活动,以及对症抗凝处理,症状消失。有21例因各种内、外科系统的并存疾病死亡,均死于术后15个月以上。根据髋关节Modified Harris评分系统[2](疼痛44分,功能47分,关节活动度5分,畸形4分,总分100分;90~100分为优,80~89分为良,70~79分为可,70分以下为差。): 术后36个月平均为92分;其中16例超过术后60个月的患者平均为89分。无深部感染、明显髋股部疼痛及髋关节脱位病例。, 百拇医药(陈稀露 庄民佗 吴伟华 吴金国 陈 玮)
【关键词】股骨颈骨折; 老年; 骨水泥; 双极; 半关节置换术
Small Incision Cement Bipolar Hemiarthroplasty for Displacsd Femoral Neck Fracture in the Elderly
, 百拇医药
CHEN Xi lu,ZHUANG Ming tuo,WU Wei hua,et al.XiaShan Orthopedics and Traumatology Hospital of Zhanjiang,Guangdong 524003,China
【Abstract】 Objective To observe the clinic effect of cement bipolar hemi arthroplasty for displacsd femoral neck fracture in the elderly,and choose more rational configuration of prosthesis for clinic.Methods From Jun.2004 to Dec.2008.67 elderly patients(Age 67 89 years old)with displaced femoral neck fracture were operated by the cement bipolar hemiarthroplasty.
, 百拇医药
There were 56 patients in Garden Types Ⅲand 11 patients in Garden Types.All expose the fracture through the Hardinge incision.The mean operating time was 45 minutes and routine transfuse 200 ml.Activity and loading status were supervised and emphasized after the operation.Results Follow up for 15 to 86 months(mean 38 months).According to Modified Harris’scoring system,the average score was postoperative 36 months 92,60 months 89.There was no case of hip dislocation or pain of hip and thigh obviously.Conclusion The hip hemiarthroplasty is consistent with the sclerotin feature of old age and the incipient stability is good.The operating time is short,the trauma and risk is little.The complication incidence rate of the short and mediate time is low after operation.It can still be considered a good therapy well to displacsd femoral neck fracture in the elderly.
, http://www.100md.com
【Key words】Femoral neck fracture; Elderly; Cement; Bipolar; Hemiarthroplasty
股骨颈骨折是老年人的常见骨折之一,随着社会的老龄化其发生率呈逐渐上升趋势。骨折后的骨不愈合和股骨头缺血性坏死仍是目前治疗上的棘手问题,因而寻求理想的治疗方法仍是骨科临床研究的焦点。除无移位型骨折可行确切有效的内固定治疗外,人工髋关节置换是近年骨科学术界的共识。股骨颈骨折的手术方案选择,仍是一个没有完全解决的问题。在2004年6月至2008年12月间,我们立足于生物力学的基础上,应用小切口骨水泥人工双极股骨头置换治疗老年移位股骨颈骨折67例,取得良好的治疗效果。报告如下。
1 临床资料
本组67例,其中:男28例,女39例;年龄67~89岁,平均72.3岁。骨折类型;头下型43例,颈中型21例,基底型3例。Garden分型:III型56例,IV型11例。其中术前患有高血压病16例,冠心病13例,糖尿病7例,脑梗死治愈后4例。
, 百拇医药
2 治疗方法
住院后常规皮牵制动止痛,手术当天应用抗生素至术后1周防止感染。持续硬外麻下进行手术。取患髋前外侧入路(改良Hardinge切口)[1],长约10 cm。分层切开皮肤、皮下和阔筋膜张肌筋膜,沿肌纤维方向部分切开臀大肌,显露股骨大粗隆和臀中肌,于大粗隆尖端前缘骨膜下剥离臀中肌止点的前1/3,L型切开臀小肌肌腱,将髋屈曲、内收和外旋,必要时亦可切断股直肌的反折头使术野尽可能向前下方扩大,十字切开关节囊,取出股骨头。股骨残端截骨面与股骨干成45°并与股骨颈轴线垂直,保留1.0~1.5 cm的股骨距。切除圆韧带。用假体柄试件扩大股骨髓腔,注意保持10~15°的前倾角,选取相应匹配的骨水泥型假体柄试行置入适宜后拔出,高压冲洗骨髓残腔及清洗术野。将骨水泥塞子置入髓腔,然后用骨水泥枪注入骨水泥并打入假体柄。骨水泥结固后套上与患者股骨头直径相同的双极假体头。牵引复位髋关节,试行各方向活动稳定,再次冲洗术野并常规注入适量抗生素液,修补缝合关节囊、臀小肌和臀中肌止点,放置负压引流管并分层缝合切口。手术耗时约40 min,输血200 ml。术后皮牵制动1周并置患肢于外展中立位,24~48 h拔除引流管。3周后逐步扶拐负重练习行走。
3 治疗结果
随访15~86个月,平均38个月。术后2例出现患侧下肢肿胀(均为左侧),拟诊为下肢深静脉血栓形成,经过抬高患肢并加强肌肉的舒缩活动,以及对症抗凝处理,症状消失。有21例因各种内、外科系统的并存疾病死亡,均死于术后15个月以上。根据髋关节Modified Harris评分系统[2](疼痛44分,功能47分,关节活动度5分,畸形4分,总分100分;90~100分为优,80~89分为良,70~79分为可,70分以下为差。): 术后36个月平均为92分;其中16例超过术后60个月的患者平均为89分。无深部感染、明显髋股部疼痛及髋关节脱位病例。, 百拇医药(陈稀露 庄民佗 吴伟华 吴金国 陈 玮)