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动力髋螺钉在股骨粗隆间骨折的应用

人工股骨头置换术在高龄股骨粗隆间骨折中的应用

目的 总结人工股骨头置换术治疗高龄患者股骨粗隆间骨折的方法和疗效。方法 2002年2月～2005年12月，采用骨水泥型双极人工股骨头置换治疗高龄股骨粗隆间新鲜骨折19例。其中男7例，女12例；年龄78～102岁，中位年龄83.3岁。摔伤13例，车撞伤6例。损伤至手术时间2～10 d。合并糖尿病9例，高血压病9例，慢性支气管炎1例（缓解期），脑梗塞后遗症2例（骨折侧肌力在Ⅳ级以上）。术前患髋Harris评分均为差；骨折按Evan’s分型：Ⅱ型2例，Ⅲ型9例，Ⅳ型8例。结果 19例获6～41个月随访，患髋均无明显疼痛。12例恢复术前行走功能，5例行走能力下降需要扶助，2例不能独立行走。术后并发下肢深静脉血栓1例，泌尿道感染1例，一过性精神障碍2例，7例术后8~37个月分别死于心肌梗死，心衰、脑出血、肺内感染等。结论 人工股骨头置换术治疗高龄患者股骨粗隆间骨折短期疗效满意，可以显著提高患者的生活质量，但应严格掌握适应证。

Assessment of the Curative Effects of DHS(Dynamic Hip Screw)Plus Bone Cement in Treating Intertrochanteric Fractures in the Elderly

:目的:探讨DHS+骨水泥治疗老年股骨粗隆间骨折的疗效。方法:回顾分析2001年1月～2006年4月48例70岁以上老年股骨粗隆间骨折病例的临床资料,对其骨折类型、骨质疏松程度、合并症及临床疗效进行分析。结果:本组术后32例获得1～4年随访,无螺钉松动、髋内翻、感染或骨折延期愈合,髋关节功能评价优良率93％。结论:DHS+骨水泥治疗老年股骨粗隆间骨折具有手术时间短、创伤小、内固定牢靠、符合生物力学分配、能早期得到功能锻炼、减少术后并发症等优点;适合各种类型老年股骨粗隆间骨折的治疗。

EFFECT OF ADJUNCTIVE CANCELLOUS SCREW IN TREATMENT OF INTERTROCHANTERIC FRACTURES WITH DYNAMIC HIP SCREW FIXATION

Objective To study the technique and effect of adjunctive cancellous screw in treatment of intertrochanteric fractures with dynamic hi p screw (DHS) fixation. Methods Between April 2004 and August 2007, 33 patients with intertrochanteric fracture were treated with DHS fixation and adjunctive cancellous screw. There were 13 males and 20 females, aging 43-82 years with an average age of 67 years. Fractures were caused by traffic accident in 7 patients, by fall ing from height in 11 patients, by sprain in 15 patients. All fractures were closed. The patients were operated 3-12 days after injury. According to Evans classification, there were 12 cases of type II, 15 cases of type III, and 6 cases of type IV. Twenty-twocases had osteoporosis. Weight bear time and compl ication were recorded. Fracture heal ing and neck-shaft angle were observed on radiogram. Hip functions were evaluated using Radford criterion. Results Thirty-three patients had no intraoperative compl ications with incision heal ing by first intension. All patients were followed up from 14 months to 38 months, with an average of 21 months. Fracture heal ing was achieved within 14 weeks to 21 weeks, with an average of 17 weeks after operations. The neck-shaft angles were (134.2 ± 13.7)° 3 days after operation, (128.6 ± 8.9)° 8 weeks after operation, and (128.5 ± 9.3)° after fracture heal ing, showing no significant difference when compared with that of the third day after operation (P gt; 0.05). According to the Radford criterion at last follow-up, the excellent and good rate of hi p function was 93.9% (excellent in 21 cases, good in 10 cases, and poor in 2 cases). Compl ications such as loosening, breakage, or grievous migration of hardware were not observed. Conclusion The adjunctive cancellous screw in treatment of intertrochanteric fractures with DHS fixation can provide counteraction of tension and rotation, promote fixation stabil ity, enhance fracture heal ing and decrease compl ication.

Evidence-Based Treatment for an Elderly Patient with Intertrochanteric Fractures

Objective To identify an evidence-based treatment for an elderly patient with intertrochanteric fractures. Methods Clinical problems were presented on the basis of the patient’s conditions, and evidence was collected from the NGC (2000 to 2009), The Cochrane Library (Issue 4, 2009), TRIP Database, PubMed (1966 to 2009) and CBM (1978 to 2009). Treating strategies were formulated in terms of the three-combination principle (best evidence, the doctor’s professional knowledge and the patient’s desire). Results Three guidelines and sixteen studies were included. The current evidence indicated that surgery was the preferred solution to intertrochanteric fractures of the elderly patient. The sliding hip screw (SHS) appeared superior to others. There was insufficient evidence to support the routine use of closed suction drainage in orthopedic surgeries. Early surgery was associated with shorter hospital stay and improved mortality. Antibiotic prophylaxis significantly reduced infections. In order to lower the risk of venous thromboembolism, pharmacological prophylaxis should be carried out when the patient was admitted to hospital and be assisted with mechanical prophylaxis after surgery. Nutritional supplementation was conducive to the recovery of the patient. Rehabilitation ought to be performed as soon as possible. Considering the patient’s condition, the treatment option was established according to the available evidence and guidelines. Short-term follow-up showed a good outcome. Conclusion Through the evidence-based method, an individual treatment plan could obviously improve the treatment effect and prognosis.

Arthroplasty for the Treatment of 56 Elderly Patients with Unstable Intertrochanteric Femoral Fracture

目的:观察高龄不稳定型粗隆间骨折人工关节置换术的治疗效果。方法:2005年1月至2008年1月收治高龄不稳定型股骨粗隆间骨折患者56例,行人工关节置换术治疗,按照Harris标准评分分析效果。结果:56例患者均顺利完成手术,平均手术时间62 min,平均住院17天。随访1～3年,术后14月因突发脑出血死亡1例,其余患者功能恢复良好。按照Harris标准评分优良率为91%。结论:高龄股骨粗隆间骨折采用人工关节置换术治疗安全有效。

股骨粗隆间骨折内固定术后并发股深动脉假性动脉瘤一例

目的总结1例股骨粗隆间骨折内固定术后并发股深动脉假性动脉瘤诊治体会。 方法2011年10月收治1例摔伤致右侧股骨粗隆间骨折的女性患者，年龄78岁。入院后采用股骨近端防旋髓内钉（proximal femoral nail antirotation，PFNA）行骨折复位内固定术。术后第9天出现患侧大腿疼痛并逐渐加重，血红蛋白降低。第13天B超检查示右大腿前侧包块。急诊行右下肢超选择性血管造影术，示股深动脉第2穿支远端假性动脉瘤形成。用弹簧圈行第2穿支动脉栓塞术。 结果栓塞术后患侧大腿疼痛明显减轻，肿胀逐渐消退，顺利出院。患者获随访2年，右股骨粗隆间骨折完全愈合，患侧髋关节功能Harris评分为优。 结论股骨粗隆间骨折内固定术后如出现不明原因患侧大腿疼痛、肿胀、血红蛋白进行性下降等，应警惕假性动脉瘤的发生，行选择性血管造影术明确并选择相应治疗方法。

股骨粗隆间骨折内固定并发症原因分析

目的 总结股骨粗隆间骨折内固定手术引起的常见并发症和产生的原因。 方法 2002 年1 月－2007 年10 月，股骨粗隆间骨折内固定手术后17 例出现并发症。其中男15 例，女2 例；年龄31 ～ 82 岁。均为闭合性骨折；新鲜骨折16 例，陈旧性骨折1 例；粉碎性骨折15 例。Evan’s 分型Ⅰ型2 例，Ⅱ型5 例，Ⅲ型7 例，Ⅳ型3 例。伤后至就诊时间1 ～ 6 h，平均2.5 h。采用动力髋螺钉固定7 例，动力髁螺钉固定6 例，股骨近端交锁髓内钉固定1 例，2 枚空心钉固定2 例，外院转入麦氏鹅头钉固定1 例。 结果 术后出现断钉后髋内翻3 例、头颈钉突出股骨头5 例、骨折复位不良4 例、感染导致慢性骨髓炎内固定失败1 例、患肢短缩3 例、患肢延长1 例。无股骨干骨折、股骨头坏死等并发症。 结论 股骨粗隆间骨折内固定术后并发症，主要由于内固定方式选择不当，术中骨折复位不良、固定不牢靠、术后处理不当等引起。

INFLUENCE OF INTEGRATION OF FRACTURE TREATMENT AND EXERCISE REHABILITATION ON EFFECTIVENESS IN PATIENTS WITH INTERTROCHANTERIC FRACTURE OF FEMUR

Objective To investigate the influence of the integration of fracture treatment and exercise rehabilitation on the effectiveness in the patients with intertrochanteric fracture of femur. Methods Between January 2007 and December 2009, 3 873 patients with intertrochanteric fracture of femur were surgically treated in 56 hospitals. Of them, 1 970 cases were treated with rehabilitation training according to scale of safety assessment of early exercise rehabilitation of patients with fractures (trial group), 1 903 cases were treated with traditional rehabilitation training methods (control group). There was no significant difference in age, gender, fracture type, internal fixation type, or postoperative safety score between 2 groups (P gt; 0.05). Results All the patients were followed up 13-49 months (mean, 30.5 months). There was no significant difference in the incidences of bone nonunion, delayed union, and systemic complication between 2 groups (P gt; 0.05); significant differences were found in the incidences of incision complication, deep vein thrombosis of the lower extremity, and the overall complication between 2 groups (P lt; 0.05). At 6 and 12 months after operation, the trial group was significantly better than the control group in the recovery of hip motion, curative effectiveness classification, and the excellent and good rate (P lt; 0.05). Conclusion The treatment of intertrochanteric fracture of the femur guided by the integration of fracture treatment and exercise rehabilitation can apparently improve the prognosis and reduce the incidence of complications.

Research progress of lateral wall injury of intertrochanteric fracture

Objective To summarize the general concept of lateral wall, the causes of lateral wall injury, and surgical strategies in order to improve the understanding of lateral wall and reduce the complications of operation. Methods The related literature on lateral wall was extensively reviewed, summarized, and analyzed. Results The superior extent of the lateral wall is vastus lateralis ridge and the inferior extent is the intersection between the lateral femoral cortex and a line drawn at a tangent to the inferior femoral neck. The integrity of the lateral wall is important to prevent the failure of fixation and reoperation of intertrochanteric fractures. The main causes of injury are that there is no suitable typing criteria as a guide, the fracture pattern shown by X-ray does not match with the actual situation of the fracture, the type of fracture is special, and the operation is improper. The main treatment is to reconstruct the lateral wall and choose different reconstruction methods according to different fracture patterns. Conclusion The lateral wall is very important for the treatment of intertrochanteric fracture. Lateral wall fracture should be internal fixation in order to minimize the risk of reoperation.