人工股骨头置换术在高龄股骨粗隆间骨折中的应用45例分析

目的：探讨人工股骨头置换术治疗高龄股骨粗隆间骨折的临床疗效。方法：对45例高龄股骨粗隆间骨折患者采用骨水泥型双极长柄人工股骨头置换术治疗。结果：经6～48个月随访,平均21个月,优良率为88．9％,无死亡病例,未出现感染、假体松动及下沉等并发症。结论：对于高龄老年人股骨粗隆间骨折,采用人工股骨头置换术临床疗效满意。     

长柄双极人工股骨头置换治疗老年粉碎性股骨粗隆间骨折的临床研究

目的：探讨长柄双极人工股骨头置换治疗老年粉碎性股骨粗隆间骨折的临床疗效。方法：从2001年12月～2003年10月近2年时间内共治疗、随访观察48例符合病例选择标准的患者，采用长柄双极人工股骨头置换治疗。结果：术后48例患者住院时间、负重行走时间及并发症观察随访情况均优于传统内固定方法。结论：对于年龄70岁以上，不稳定、粉碎性股骨粗隆间骨折患者采用长柄双极人工股骨头置换治疗是可行的。     

人工股骨头置换治疗老年不稳定性股骨粗隆间骨折

目的:观察人工股骨头置换治疗老年不稳定性股骨粗隆间骨折的疗效。方法:采用人工股骨头置换治疗老年不稳定性股骨粗隆间骨折22例。结果:随访6~18个月,未出现假体抬动、下沉及关节疼痛等。优11例,良8例,中3例。优良率为83.36%。结论:人工股骨头置换是治疗老年不稳定性股骨粗隆间骨折一种较好的方法。     

人工股骨头置换治疗高龄不稳定性股骨粗隆间骨折42例分析

目的分析人工股骨头置换治疗高龄不稳定性股骨粗隆间骨折的临床疗效。方法 2007-03-2010-09深圳平乐骨伤科医院老年骨科应用人工股骨头置换治疗高龄不稳定性股骨粗隆间骨折42例,骨折类型按改良Evans分型:ⅡA型8例,ⅡB型11例,Ⅲ型23例,并对42例患者进行随访,分析其疗效。结果 42例高龄不稳定性股骨粗隆间骨折进行人工股骨头置换,随访时间3～32个月,平均13个月。术后开始负重行走时间为3～11d,平均6d。按Harris评分标准:优11例,良24例,可5例,差2例,优良率达83.3%。结论人工股骨头置换治疗高龄不稳定性股骨粗隆间骨折能使患者早日下地行走,恢复髋关节的功能,并发症少,临床效果良好。     

高龄股骨粗隆间骨折病人人工半髋关节置换术后切口感染的护理

<正>股骨粗隆间骨折为高龄老人常见骨折,手术治疗一般采用骨水泥型双极人工半髋关节置换术。术后切口感染为人工半髋关节置换术后最严重的并发症之一,而预防术后切口感染则是提高人工半髋关节置换术成功率的一个关键因素。我院2012年采用骨水泥型双极人工股骨头置换术治疗62例高龄股骨粗隆间骨折病人,通过加强预防切口感染的一系列护理措施,有效     

股骨头置换与内固定治疗高龄不稳定性股骨粗隆间骨折比较

目的:通过临床观察和研究比较人工股骨头置换与内固定治疗高龄、不稳定性股骨粗隆间骨折效果。方法:对2007-01/2009-02手术治疗的粗隆间骨折患者98例分为A组31例:采用人工股骨头置换手术,均为骨水泥型;B组67例,其中DHS内固定治疗的为51例,PFN内固定治疗的为16例。结果:术后随访平均时间为1a,A组创伤小,手术时间短,出血少,术后卧床时间短,并发症少,满意度及生活信心指数较高;B组创伤大,手术时间长,出血多,术后卧床时间长,并发症多,满意度及生活信心指数较低。结论:治疗高龄、骨质疏松、不稳定性股骨粗隆间骨折中人工股骨头置换术(骨水泥型)优于内固定术。     

90岁以上非稳定性股骨粗隆间骨折人工股骨头置换术的护理

据国外文献报告高龄患者股骨粗隆间骨折保守治疗的病死率在1年内可高达50%以上[1].2000年1月至2004年8月,本院采用骨水泥型双动人工股骨头置换治疗90岁以上非稳定性股骨粗隆间骨折患者12例,获得了满意的疗效,现将护理报告如下.     

人工股骨头置换治疗老年股骨粗隆间粉碎性骨折疗效观察

目的：观察用人工股骨头置换术治疗老年人股骨粗隆间骨折疗效。方法：回顾性分析应用骨水泥固定人工股骨头假体治疗新鲜老年人粗隆间骨折29例的临床资料。结果：人工股骨头置换治疗老年股骨粗隆间粉碎性骨折的手术时间短，出血量少，髋关节功能恢复好。随访6～24个月，疗效满意。以髋关节活动度、疼痛程度及生活自理情况为观察指标，优良率达93％。结论：人工股骨头置换术治疗老年人股骨粗隆间骨折创伤小，患髋功能恢复快，可早期下地，减少并发症，是治疗老年粗隆间粉碎性骨折的理想方法。     

老年股骨粗隆间骨折行人工股骨头置换术26例分析

目的总结人工股骨头置换治疗老年股骨粗隆间骨折的疗效。方法采用人工股骨头置换治疗65岁以上股骨粗隆间骨折的患者26例,其中按照Evans分型:Ⅱ型2例,Ⅲa型10例,Ⅲb型11例,Ⅳ型3例。平均随访15个月,观察下地时间及髋关节活动。结果 26例手术均顺利,无关节感染,脱位或假体周围骨折。按照髋关节Harris评分标准,均可以达到70分或以上。结论人工股骨头置换术治疗老年股骨粗隆间骨折具有手术创伤小,并发症少,可以提高患者的生活质量,疗效满意。     

骨水泥型人工股骨头置换术治疗高龄股骨粗隆间骨折体会

目的总结骨水泥型人工股骨头置换治疗高龄股骨粗隆间骨折患者手术适应证的掌握、术中的关键环节及其临床疗效。方法回顾性分析2010年1月至2012年10月采用骨水泥型人工股骨头置换治疗高龄股骨粗隆间骨折15例患者的临床资料,其中EvansⅡ型5例,Ⅲ型4例,Ⅳ型6例。结果 15例经3~26个月随访,平均随访13个月,优9例,良4例,优良率为86.67%。无1例死亡。未出现假体松动及下沉现象,髋关节功能良好,优于传统内固定术。严格把握人工股骨头置换术的手术适应证及认真控制术中的关键环节是获得手术成功的关键。结论骨水泥型人工股骨头置换治疗高龄患者股骨粗隆间骨折具有操作简单、手术时间短、更符合生物力学、尽快恢复功能的特点,是目前较好的治疗方法。     

人工双极股骨头置换中大转子不同固定方法的比较

背景:钢丝捆绑固定大小转子间骨折在髋关节置换过程中被广泛采用,但对于严重粉碎的骨质疏松骨折可能会加重骨折或无法固定所有骨折块。目的:对比人工双极股骨头置换治疗老年骨质疏松性不稳定转子间骨折中不同固定方法的效果。方法:在人工双极股骨头置换治疗34例骨质疏松性老年患者股骨转子间不稳定骨折中,采用钢丝捆绑固定大转子骨折块19例,采用爱惜邦聚丁酯带针缝线固定大转子骨折块15例。结果与结论:所有大转子骨折均愈合,无骨折移位、关节脱位、假体下沉、断裂、松动等并发症发生。所有患者日常生活能自理,无严重疼痛、功能障碍,疗效满意。两组骨折愈合时间及Hariss评分差异无显著性意义(P>0.01)。爱惜帮捆绑固定组手术时间及术中出血量较钢丝捆绑组少(P<0.01)。表明在人工双极股骨头置换治疗老年骨质疏松伴大转子粉碎的不稳定股骨转子间骨折患者过程中,采用爱惜帮缝合线固定可明显缩短手术时间、减少术中出血量。     

Endoprosthetic replacement of unstable, comminuted intertrochanteric fracture of the femur in the elderly, osteoporotic patient: a review

PURPOSE: To summarize currently existing evidence regarding prosthetic replacement for the treatment of intertrochanteric (extracapsular) hip fractures and their complications. METHOD: Report of a clinical investigation program conducted at one academic institution and literature review. RESULTS: Although the majority of intertrochanteric fractures can be successfully managed with operative reduction and fixation, some patients may benefit from prosthetic replacement. For older patients with severe osteoporosis or comminution there are some definite advantages of prosthetic replacement over reduction and fixation. If the prosthetic replacement has been properly performed, there is very little concern over immediate ambulation and weight-bearing. This decreases the incidence of postoperative complications, such as pulmonary infection, atelectasis, and pressure sores. In addition, acute prosthetic replacement eliminates the possibility of excessive collapse compromising walking function, mal-union, as well as the uncommon problems of non-union and avascular necrosis. Likewise, hip arthroplasty is an effective salvage procedure after the failed internal fixation of an intertrochanteric fracture in an older patient. Most patients report good pain relief, and surprisingly few serious orthopaedic complications are associated with this procedure.There are, however, a number of methodological concerns regarding previous studies which have examined the use of prosthetic replacement for the treatment of comminuted intertrochanteric fractures or non-union in the elderly patient. Many have been small case series without a control group. There are few comparative studies and even fewer prospective, randomized controlled trials which have compared prosthetic replacement surgery with standard internal fixation techniques in the long run. CONCLUSIONS: Older patients with severe osteoporosis or comminution may benefit from prosthetic replacement to treat intertrochanteric fractures and non-unions. Overall, rigorously conducted prospective randomized clinical trials with long-term follow-up are lacking. Despite these methodological reservations, several authors have reported successful prosthetic replacement for treating intertrochanteric fractures and their complications in elderly patients. Few serious orthopaedic complications are associated with these procedures, and most patients have good pain relief.     

Endoprosthetic replacement of unstable, comminuted intertrochanteric fracture of the femur in the elderly, osteoporotic patient: A review

Purpose: To summarize currently existing evidence regarding prosthetic replacement for the treatment of intertrochanteric (extracapsular) hip fractures and their complications.

Method: Report of a clinical investigation program conducted at one academic institution and literature review.

Results: Although the majority of intertrochanteric fractures can be successfully managed with operative reduction and fixation, some patients may benefit from prosthetic replacement. For older patients with severe osteoporosis or comminution there are some definite advantages of prosthetic replacement over reduction and fixation. If the prosthetic replacement has been properly performed, there is very little concern over immediate ambulation and weight-bearing. This decreases the incidence of postoperative complications, such as pulmonary infection, atelectasis, and pressure sores. In addition, acute prosthetic replacement eliminates the possibility of excessive collapse compromising walking function, mal-union, as well as the uncommon problems of non-union and avascular necrosis. Likewise, hip arthroplasty is an effective salvage procedure after the failed internal fixation of an intertrochanteric fracture in an older patient. Most patients report good pain relief, and surprisingly few serious orthopaedic complications are associated with this procedure.

There are, however, a number of methodological concerns regarding previous studies which have examined the use of prosthetic replacement for the treatment of comminuted intertrochanteric fractures or non-union in the elderly patient. Many have been small case series without a control group. There are few comparative studies and even fewer prospective, randomized controlled trials which have compared prosthetic replacement surgery with standard internal fixation techniques in the long run.

Conclusions: Older patients with severe osteoporosis or comminution may benefit from prosthetic replacement to treat intertrochanteric fractures and non-unions. Overall, rigorously conducted prospective randomized clinical trials with long-term follow-up are lacking. Despite these methodological reservations, several authors have reported successful prosthetic replacement for treating intertrochanteric fractures and their complications in elderly patients. Few serious orthopaedic complications are associated with these procedures, and most patients have good pain relief.     

Endoprosthetic replacement of unstable,comminuted intertrochanteric fracture of the femur in the elderly,osteoporotic patient: A review

Purpose: To summarize currently existing evidence regarding prosthetic replacement for the treatment of intertrochanteric (extracapsular) hip fractures and their complications.

Method: Report of a clinical investigation program conducted at one academic institution and literature review.

Results: Although the majority of intertrochanteric fractures can be successfully managed with operative reduction and fixation, some patients may benefit from prosthetic replacement. For older patients with severe osteoporosis or comminution there are some definite advantages of prosthetic replacement over reduction and fixation. If the prosthetic replacement has been properly performed, there is very little concern over immediate ambulation and weight-bearing. This decreases the incidence of postoperative complications, such as pulmonary infection, atelectasis, and pressure sores. In addition, acute prosthetic replacement eliminates the possibility of excessive collapse compromising walking function, mal-union, as well as the uncommon problems of non-union and avascular necrosis. Likewise, hip arthroplasty is an effective salvage procedure after the failed internal fixation of an intertrochanteric fracture in an older patient. Most patients report good pain relief, and surprisingly few serious orthopaedic complications are associated with this procedure.

There are, however, a number of methodological concerns regarding previous studies which have examined the use of prosthetic replacement for the treatment of comminuted intertrochanteric fractures or non-union in the elderly patient. Many have been small case series without a control group. There are few comparative studies and even fewer prospective, randomized controlled trials which have compared prosthetic replacement surgery with standard internal fixation techniques in the long run.

Conclusions: Older patients with severe osteoporosis or comminution may benefit from prosthetic replacement to treat intertrochanteric fractures and non-unions. Overall, rigorously conducted prospective randomized clinical trials with long-term follow-up are lacking. Despite these methodological reservations, several authors have reported successful prosthetic replacement for treating intertrochanteric fractures and their complications in elderly patients. Few serious orthopaedic complications are associated with these procedures, and most patients have good pain relief.     

人工股骨头置换治疗老年不稳定转子间骨折的临床疗效

【目的】探讨人工股骨头置换治疗老年转子间不稳定骨折的可行性和临床疗效。【方法】对176例老年不稳定转子间骨折均行人工股骨头置换术。【结果】2例围术期死亡,3例切口软组织感染,2例术后早期人工关节后脱位,22例在术后3年内因内科疾病等死亡和失访。对154例患者进行随访,且资料完整,按Harris评分系统优良率为96％（148／154）。【结论】人工股骨头置换术是治疗老年转子间不稳定骨折的一种方法。     

人工股骨头置换治疗高龄转子间骨折与股骨颈骨折：随访比较

背景：人工股骨头置换治疗高龄移位股骨颈骨折已成为首选治疗方案,但是否应用关节置换作为转子间骨折的初次治疗,目前国内学者还有争论。目的：通过比较人工股骨头置换治疗高龄转子间骨折与股骨颈骨折的疗效,评价人工股骨头置换治疗高龄转子间骨折的效果。方法：纳入老年髋部骨折患者90例,年龄≥80岁,转子间骨折组35例,股骨颈骨折组55例。患者均采用骨水泥型人工关节置换。随访1-5年,从置换过程时间、出血量,置换后负重时间、并发症,Harris评分情况进行比较分析。结果与结论：两组平均随访2.8年,在髋关节间隙变化、疼痛、假体柄松动下沉,假体翻修率等方面,两组比较差异无显著性意义（P〉0.05）;置换过程中出血量、置换后负重时间、Harris评分差异无显著性意义（P〉0.05）;转子间骨折组比股骨颈骨折组置换时间稍长（P〈0.01）。说明人工关节置换治疗高龄不稳定的转子间粉碎性骨折,具有与股骨颈骨折关节置换同样的治疗效果。     

骨质疏松性髋部骨折:不同金属植入物治疗的比较

背景:金属植入物内固定治疗年轻股骨颈骨折患者效果较好,但有关金属植入物治疗老年股骨颈骨折患者的效果较少见报道.目的:比较采用不同金属植入物治疗老年骨质疏松性髋部骨折的效果.方法:选择本院1998-01/2008-12老年骨质疏松性髋部骨折患者237例,年龄60～96岁.采用空心加压螺钉置入内固定治疗32例,解剖钢板置入内固定23例,动力髋螺钉置入内固定41例,双极股骨头置换111例,人工全髋关节置换30例.比较各组并发症发生率及髋关节功能恢复情况.结果与结论:空心加压螺钉、解剖钢板、动力髋螺钉置入内固定治疗并发症发生率均高明显于双极股骨头置换、全髋关节置换治疗(P<0.01);空心螺钉组、股骨近端解剖钢板、动力髋螺钉置入内固定治疗优良率明显低于双极股骨头置换及全髋关节置换治疗(P<0.001,P<0.01).结果提示老年骨质疏松性股骨颈骨折应首选人工关节置换(双极股骨头置换或全髋置换),对Garden型可选用空心螺钉固定,转子间骨折Jensen-EvansⅠ～Ⅱ型可选用动力髋螺钉及股骨近端解剖型钢板置入内固定;Jensen-EvansⅡ～Ⅲ型骨质疏松性转子间骨折关节置换是理想的选择.     

人工双极股骨头置换中大转子不同固定方法的比较

背景：钢丝捆绑固定大小转子间骨折在髋关节置换过程中被广泛采用,但对于严重粉碎的骨质疏松骨折可能会加重骨折或无法固定所有骨折块。目的：对比人工双极股骨头置换治疗老年骨质疏松性不稳定转子间骨折中不同固定方法的效果。方法：在人工双极股骨头置换治疗34例骨质疏松性老年患者股骨转子间不稳定骨折中,采用钢丝捆绑固定大转子骨折块19例,采用爱惜邦聚丁酯带针缝线固定大转子骨折块15例。结果与结论：所有大转子骨折均愈合,无骨折移位、关节脱位、假体下沉、断裂、松动等并发症发生。所有患者日常生活能自理,无严重疼痛、功能障碍,疗效满意。两组骨折愈合时间及Hariss评分差异无显著性意义（P〉0.01）。爱惜帮捆绑固定组手术时间及术中出血量较钢丝捆绑组少（P〈0.01）。表明在人工双极股骨头置换治疗老年骨质疏松伴大转子粉碎的不稳定股骨转子间骨折患者过程中,采用爱惜帮缝合线固定可明显缩短手术时间、减少术中出血量。     

骨水泥型双极股骨头假体应用于高龄不稳定股骨转子间骨折16例

选择苏州大学附属第一医院骨科自2006-07/2008-11行骨水泥型双极股骨头假体置换治疗高龄不稳定股骨转子间骨折患者16例,男5例,女11例;平均年龄84岁.其中,5例获得随访.假体采用北京蒙太因公司骨水泥型双极股骨头假体,置换后常规抗生素治疗5-7d,并给予镇痛、抗凝等药物.平均随访时间14个月,1例于置换10个月后因肺心病死亡,3例存在异位骨化,随访期间均未见假体松动、脱位现象.髋关节功能按Harris评分,优3例,良9例,可3例,差0例,优良率为80%.结果提示骨水泥型双极人工股骨头置换治疗高龄不稳定股骨转子间骨折是积极、有效的,但应严格掌握手术适应证.