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。

Comparison of different fixations of great trochanteric fragments in bipolar femoral head replacement for elderly patients with unstable intertrochanteric fractures

BACKGROUND: Steel wires for fixation of intertrochanteric fractures are widely applied in total hip replacement. However, this method can aggravate severe osteoporotic fractures or cannot fix all the bone blocks. OBJECTIVE: To evaluate the clinical results of different fixation methods of great trochanter fragments in bipolar femoral head replacement for the treatment of unstable intertrochanteric fractures in elderly patients. METHODS: Thirty-four cases of unstable intertrochanteric fracture were treated with bipolar femoral head replacement. Of 34 patients, 19 cases were fixed by steel wires for fragment of trochanter, 15 cases were fixed by Ethibond Excel Polyester Sutures. The operation time, bleeding, clinical results and conditions after operations were recorded and analyzed. RESULTS AND CONCLUSION: All the fractures were healed. No fracture displacement, no loosen, dislocation sinking or fracture of the prosthesis was found in the followed-up cases. There was no significant difference between two groups in a Harris score (P > 0.01). All the patients could self-care and be satisfied with no pain and dysfunction. There were less bleeding and shorter operation time in the Ethibond Excel Polyester Sutures fixed cases than steel wires fixed cases (P < 0.01). Using Ethibond Excel Polyester Sutures to fix great trochanter fragments is effective for management of unstable intertrochanteric fracture especially with osteoporosis in the elderly.