两种方法治疗高龄股骨粗隆间骨折疗效比较

[目的]比较人工股骨头置换与股骨近端髓内针(PFNA)治疗高龄患者不稳定股骨粗隆间骨折的临床疗效。[方法]54例高龄不稳定股骨粗隆间骨折患者随机分为人工股骨头置换术组(A组)及PFNA固定术组(B组)。对两组患者的出血量、手术时间、负重行走时间、髋关节功能及术后并发症等指标进行统计学分析。[结果]两组的手术出血量及手术时间差异无统计学意义(P>0.05)。但在术后早期负重活动、Harris评分及术后并发症方面,人工股骨头置换组优于PFNA固定组,差异有统计学意义(P<0.05)。[结论]相对于PFNA固定组,人工股骨头置换治疗高龄不稳定股骨粗隆间骨折具有卧床时间短,术后并发症少,早负重及关节功能恢复快等优点。     

PFNA与人工股骨头置换治疗高龄不稳定股骨粗隆间骨折的对比研究

目的探讨股骨近端防旋髓内钉(PFNA)与人工股骨头置换(FHR)治疗高龄不稳定股骨粗隆间骨折的临床应用。方法 114例高龄股骨粗隆间骨折分别采用PFNA和FHR治疗,PFNA组79例,FHR组35例。对两组术中情况、术后功能及并发症等进行比较。结果所有患者均获随访6～24个月,平均18.6个月。PFNA组较FHR组手术时间短、术中出血量少,但术后下床时间较长,差异有统计学意义(P<0.05);两组术后1年髋关节功能Harris评分差异无统计学意义(P>0.05)。结论对于高龄股骨粗隆间骨折的治疗,人工股骨头置换更适合于重度骨质疏松,骨折粉碎尤其是合并股骨小粗隆骨折患者;PFNA内固定适合于骨骼质量好,股骨大粗隆相对完整、轻度移位者。     

外固定与髓内固定治疗高龄股骨粗隆间骨折

[目的]比较股骨近端I型外固定架与股骨近端防旋转髓内钉(proximal femoral nail antirotation,PFNA)治疗高龄、高危患者股骨粗隆间骨折的疗效,分析并发症发生原因及预防措施。[方法]高龄、高危股骨粗隆间骨折患者61例随机分为两组,30例采用股骨近端I型外固定架外固定(外固定组),31例行PFNA内固定(PFNA组),对手术时间、术中术后出血、下床时间、治疗费用、功能恢复情况、骨折愈合时间和并发症情况进行比较。[结果]外固定组比PFNA组手术及麻醉时间明显缩短(17.3±2.5)min vs(40.7±3.4)min,术中出血量明显减少(75.0±5.0)ml vs(341.0±34.0)ml,治疗费用显著降低(1.1±0.2)万元vs(1.8±0.3)万元,两组间差异有统计学意义(P0.05)。但下床时间、骨折愈合时间、术后并发症、Harris评分和功能恢复优良率两组相似,差异无统计学意义(P0.05)。[结论]股骨近端I型外固定架外固定与PFNA内固定治疗股骨粗隆间骨折的临床疗效相似,均为微创固定高龄、高危患者股骨粗隆间骨折的有效方法,外固定架在缩短手术时间及减少术中、术后出血量及降低治疗费用上有优势。     

PFNA内固定与人工股骨头置换术治疗高龄骨质疏松性股骨粗隆间骨折的比较

目的探讨应用股骨近端防旋髓内钉(PFNA)治疗高龄骨质疏松性股骨粗隆间骨折的疗效。方法回顾性分析本院自2010-01—2014-12实施PFNA内固定治疗的52例高龄股骨粗隆间骨折,并对照同期实施人工股骨头置换(FHR)的47例患者,比较2组手术时间、术中术后出血量、住院时间、术后并发症及术后髋关节功能Harris评分等综合指标。结果所有患者获得平均18(12~24)个月随访。2组手术前后颈干角、前倾角均恢复满意。PFNA组在术中出血量、术后出血量、住院时间上与FHR组无明显差别,差异无统计学意义(P0.05);但PFNA组在手术时间上较FHR组短,差异有统计学意义(P0.05);PFNA组在关节脱位、深静脉血栓、术后肺部感染方面发生率较FHR组低,差异有统计学意义(P0.05);PFNA组术后6、12、18个月髋关节功能Harris评分优于FHR组,差异有统计学意义(P0.05)。结论采用PFNA治疗老年骨质疏松性粗隆间骨折与FHR相比,术后并发症少,功能恢复好,值得临床推广。     

两种手术方式治疗外侧壁危险型股骨粗隆间骨折的疗效比较

[目的]对比分析动力髋螺钉(DHS)与股骨近端抗旋髓内钉(PFNA)治疗外侧壁危险型股骨粗隆间骨折的临床疗效。[方法]回顾76例外侧壁危险型股骨粗隆间骨折患者病例资料,根据治疗时的手术方法分为2组:DHS组(38例)给予DHS治疗;PFNA组(38例)给予PFNA治疗。对比分析两组患者围手术期指标(手术时间、术中失血量、切口长度、住院时间)、术后骨折愈合时间、并发症发生率、术后髋关节功能评分等。[结果]PFNA组手术时间、术中失血量、切口长度、住院时间分别为(76.4±16.7)min、(139.8±65.2)ml、(4.31±0.21)cm、(10.6±3.7)d,显著低于DHS组的(99.5±20.4)min、(296.7±43.2)ml、(7.42±0.64)cm、(12.1±3.8)d,差异均具有统计学意义(P<0.05)。PFNA组术后骨折愈合时间为(12.4±2.7)d,显著低于DHS组的(19.5±3.4)d,差异有统计学意义(P<0.05)。PFNA组总的优良率为84.2%,明显高于DHS组的52.6%,差异有统计学意义(P<0.05)。PFNA组并发症率为10.5%,低于DHS组的36.8%,差异有统计学意义(P<0.05)。[结论]PFNA和DHS均可有效治疗外侧壁危险型股骨粗隆间骨折,PFNA具有手术时间短、创伤小、术后恢复快、并发症少的优点。     

PFNA与FHR治疗老年不稳定股骨转子间骨折的成本效益分析

[目的]对股骨近端防旋髓内钉(PFNA)和人工股骨头置换(FHR)治疗老年不稳定转子间骨折进行成本效益分析,为合理选择手术方案提供依据。[方法]回顾性分析本院2016年1月～2018年4月收治的老年不稳定转子间骨折患者126例,按手术方式分为两组,PFNA组65例,FHR组61例,比较两组1年内骨折相关费用,采用髋部骨折功能恢复量表(FRS)评估手术疗效,并比较两组患者成本-效果比和增量成本-效果比。[结果]两组患者在术前等待时间、住院日方面差异无统计学意义(P>0.05);PFNA组手术时间显著短于FHR组(P<0.05),PFNA组术中出血量显著少于FHR组(P<0.05)。术后3、6个月FHR组患者FRS评分均显著高于PFNA组(P<0.05)。1年内PFNA组治疗相关费用显著低于FHR组[(50 707.61±9 160.07)元vs (59 429.91±24 783.98)元,P<0.05],术后1年PFNA组FRS评分低于FHR组,但差异无统计学意义[(72.64±7.85) vs (75.01±6.25), P>0.05]。PFNA组和FHR组平均每获得1分FRS评分分别需花费698.07元和792.29元;FHR组与PFNA组相比评分每多出1分需多花费3 680.30元。[结论]股骨近端防旋髓内钉与人工股骨头置换治疗老年不稳定型股骨转子间骨折均可取得满意疗效,但PFNA成本更低,从卫生经济学角度考虑可能更具有经济学效益。     

不同体位下股骨近端防旋髓内钉治疗股骨粗隆间骨折的临床研究

[目的]比较仰卧位和侧卧位行股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)治疗老年股骨粗隆间骨折的临床疗效。[方法]分析2011年12月~2017年2月在本院收治的31例行股骨近端防旋髓内钉(PFNA)内固定治疗的股骨粗隆间骨折患者,其中采用侧卧位16例,仰卧位牵引床15例。对两组术中的出血量、手术时间、术后VAS评分、骨折愈合时间,以及术后6个月后的Harris髋关节功能评分进行比较。[结果]侧卧位组术中出血量、手术时间、术后VAS评分比仰卧位组有优势(P<0.05),而在骨折愈合时间及术后6个月Harris髋关节功能评分方面两组比较差异无统计学意义(P>0.05)。[结论]侧卧位行PFNA治疗股骨粗隆间骨折具有出血少、创伤小、手术时间短、操作简单、术后恢复快等优点,值得在临床上推广使用。     

不同手术方法治疗老年股骨粗隆间骨折的效果分析

目的比较股骨近端防旋髓内钉(PFNA)内固定和人工股骨头置换术(FHR)治疗老年股骨粗隆间骨折的效果。方法抽取2016-12-2019-01间收治的70例老年股骨粗隆间骨折患者,随机分为2组,PFNA组(34例)采用PFNA,FHR组(36例)采用FHR治疗。观察2组手术时间、术中出血量,以及术后完全负重时间和并发症发生率。采用Harris评分比较2组患者术后12个月的髋关节功能。结果 FHR组手术时间长于PFNA组,术中出血量多于对照组,但术后并发症发生率低于对照组,术后完全负重时间短于PFNA组,差异均有统计学意义(P<0.05)。2组患者术后12个月时Harris评分比较,差异无统计学意义(P>0.05)。结论 PFNA和FHR治疗老年股骨粗隆间骨折均有较好效果,其中PFNA具有创伤小、操作简单等特点;而FHR术后卧床时间更短,能早期负重,并发症发生率低。可根据患者病情、术者的经验等全面评估后合理选择。     

PFNA内固定与人工股骨头置换术治疗高龄股骨粗隆间骨折疗效比较

目的对比分析股骨近端防旋髓内钉(PFNA)内固定与人工股骨头置换术治疗高龄骨质疏松性股骨粗隆间骨折的疗效。方法 120例高龄股骨粗隆间骨折随机分为两组:A组(54例)采用股骨粗隆间骨折专用假体行人工股骨头置换术;B组(66例)采用PFNA内固定。结果 118例获随访12～52个月,平均32.6个月。两组扶拐下地活动时间(A组平均3.8 d,B组平均4.2 d)差异无统计学意义(P>0.05);手术时间、术中失血量及术后并发症发生率差异有显著统计学意义(P<0.01)。结论对高龄骨质疏松性股骨粗隆间骨折采用PFNA内固定后创伤小、效果良好,而人工股骨头置换创伤较大,是特殊情况下的选择。     

PFNA内固定术治疗高龄不稳定股骨粗隆间骨折效果观察

目的比较PFNA和DHS内固定术治疗高龄不稳定股骨粗隆间骨折的效果。方法根据不同术式将64例高龄不稳定股骨粗隆间骨折患者分为2组,各32例。对照组实施DHS术,观察组行PFNA术。比较2组手术情况及术后髋关节Harris评分。结果观察组手术时间、术中出血量均明显低于对照组,差异有统计学意义(P0.05)。随访12个月,2组骨折愈合时间及髋关节Harris评分差异无统计学意义(P0.05)。结论对高龄不稳定股骨粗隆间骨折患者实施DHS和PFNA治疗,均可获得满意效果。但PFNA的手术时间短、出血量少、可作为治疗高龄股骨粗隆间骨折的首选术式。     

股骨头毁损三联征:股骨头骨折-脱位合并股骨颈骨折

股骨头合并同侧股骨颈骨折是一种严重而复杂的创伤,保髋手术大多会失败。其治疗的难点及预后的关键在股骨颈骨折上。鉴于股骨颈骨折的发生与股骨头骨折-脱位之间存在明显的、前后关联的贯序特点,笔者认为以股骨头毁损三联征（disastrous triad of femoral head,DTFH）来概括这种类型的损伤,更能反映其损伤机制和预后特点。结合临床观察和文献资料,DTFH可分为3个类型：Ⅰ型,普通型DTFH,股骨颈骨折的发生紧随于股骨头骨折-脱位之后,是同一暴力造成的损伤;Ⅱ型,医源型DTFH,是在股骨头骨折-脱位的诊疗过程中发生了医源性股骨颈骨折;Ⅲ型,应力型DTFH,发生于股骨头骨折-脱位的治疗之后,在股骨头骨折面的远侧缘发生应力性股骨颈骨折。本文对各型DTFH的临床特点进行了初步的讨论。     

Distal femoral allograft for massive proximal femoral deficiency

Background?Although indomethacin is effective in preventing heterotopic ossification (HO) after primary total hip arthroplasty, side effects are frequently observed. In the last decade a new class of drugs—the COX-2 selective nonsteroidal anti-inflammatory drugs—has been developed. To investigate the effect of these COX-2 selective NSAIDs on heterotopic ossification (HO) after primary total hip arthroplasty (THA), we conducted a randomized controlled trial using either indomethacin or rofecoxib for 7 days.

Methods?186 patients received either indomethacin 3 times daily, or rofecoxib twice, and 1 placebo, daily for 7 days. HO was graded according to the 1-year postoperative radiographs according to the Brooker classification.

Results?12 of the 186 patients included discontinued their medication before the end of the trial due to side effects. The remaining 174 patients were included in the analysis. In the indomethacin group (n = 89), 77 patients (87%) showed no HO, 9 showed HO of grade 1 and 3 showed HO of grade 2 according to the Brooker classification. In the rofecoxib group (n = 85) 73 patients (86%) showed no ossification, 9 showed grade 1, and 3 showed grade 2.

Interpretation?The prophylactic effect of rofecoxib for 7 days in preventing heteropic ossification after primary total hip arthroplasty is comparable to the effect of indomethacin given for 7 days. These results indicate that the development of HO follows a COX-2 pathway.     

Simultaneous proximal femoral rotational and distal femoral varus osteotomies for femoral retroversion and genu valgum

Whereas excess femoral anteversion and its related symptoms have been described many times, excess femoral retroversion is less well documented. We report the case of a 30-year-old woman who had a history of chronic bilateral hip and knee pain and evidence of excess femoral retroversion, genu valgum, early-onset lateral and patellofemoral compartment osteoarthritis of both knees, and hip arthritis. She experienced symptomatic relief after undergoing staged bilateral simultaneous proximal femoral rotational and distal femoral lateral opening wedge osteotomies. Although this combination of alignment problems is not an infrequent clinical occurrence, we have found no literature on this condition or treatment. The patient provided written informed consent for print and electronic publication of this case report.     

Extensively porous-coated femoral revision for severe femoral bone loss

Of 275 femoral revisions done at our institution from 1982 to 1986, we identified 34 patients (35 hips) who represented the senior author's (C.A.E., Sr.) most difficult revision cases as a result of extensive femoral bone loss at least 10 cm below the lesser trochanter. The patients were revised with fully porous-coated femoral components ≥190 mm. We evaluated 25 of the patients (26 hips) who had a minimum 10-year follow-up (mean, 13.3 years). Survivorship was 89% at 10 years with femoral revision as the endpoint (Kaplan-Meier). The femoral aseptic loosening rate was 15% (4 of 26). Three stems were loose but did not warrant reoperation. One stem was revised for aseptic loosening, 1 was revised for septic loosening, and 1 was revised for a fractured femoral component. Bypassing weak or absent femoral bone with an extensively porous-coated stem is an effective reconstructive technique for patients with extensive femoral bone loss.