半髋置换加钢丝环扎术在高龄不稳定粗隆间骨折的应用

目的分析半髋关节置换术加钢丝环扎术治疗高龄不稳定股骨粗隆间骨折的临床效果。方法回顾性分析2014年6月~2015年2月40例高龄不稳定股骨粗隆间骨折患者采取骨水泥半髋置换加钢丝环扎术治疗的临床资料,其中男性17例,女性23例;年龄75~90岁,平均(82.2±4.8)岁。统计分析患者手术时间、手术出血量、切口长度、术后下地时间、术后引流量、骨折愈合时间和完全负重时间,评估髋关节功能。结果本组40例患者均成功完成手术,切口均达到甲级愈合;术后随访时间为9~12个月,平均(11.3±1.2)月。手术时间(128.4±17.4)min,手术出血量(309.3±43.2)m L,切口长度(14.2±2.4)cm,术后下地时间(13.5±2.9)d,术后引流量(296.8±98.4)m L,骨折愈合时间(4.1±0.7)个月,完全负重时间(4.6±0.5)个月。末次随访时,髋关节功能优14例、良16例、可8例、差2例,优良率达到75.00%。结论半髋关节置换术加钢丝环扎术治疗高龄不稳定股骨粗隆间骨折手术效果可靠、并发症少,但是手术时间长、出血量大,部分高龄患者可能不适宜采用该手术。

Application of semi-hip replacement combined with wire cerclage in elderly patients with unstable intertrochanteric fractures

Objective To study the clinical effect of semi-hip replacement combined with wire cerclage for elderly patients with unstable intertrochanteric fractures.Methods Clinical data of 40 elderly patients diagnosed with unstable intertrochanteric fractures undergoing cemented hip replacement combined with wire cerclage were ana-lyzed retrospectively.Among them 17 were male and 23 were female with an average age of ( 82.2 ±4.8 ) years (75-90 years) .The operation time,operational blood loss,incision length,ambulation time,post-operative drianage vol-ume,healing time and full weight-bearing time were analyzed and the hip joint function was evaluated. Results All the 40 patients completed the surgery successfully and all incisions achieved good healing;the postoperative follow-up time was 9 to 12 months,averaging (11.3 ±1.2) months.The average operative time was (128.4 ±17.4) min, blood loss was (309.3 ±43.2) mL,incision length was (14.2 ±2.4) cm,postoperative ambulation time was (13.5 ±2.9)d,postoperative drainage was (296.8 ±98.4) mL,fracture healing time was (4.1 ±0.7) months,and the full weight-bearing time was (4.6 ±0.5) months.At the last follow-up,the hip joint function was excellent in 14 ca-ses,good in 16 cases,fair in 8 cases and poor in 2 cases,with an excellent and good rate of 75.00%.Conclusion Semi-hip replacement combined with wire cerclage for the treatment of unstable intertrochanteric fracture in the elderly has reliable effect,fewer complications,while needs long time of surgery and results in large amount of bleeding.Some elderly patients may not be suitable for this surgery.