股骨转子间骨折人工股骨头置换术中股骨距的重建

目的探讨人工髋关节置换术在治疗老年股骨转子问骨折时股骨距重建的意义。方法对32例股骨转子间骨折（男24例。女8例；年龄65～93岁，平均74．6岁）在股骨头置换术中进行股骨距重建，采用复位固定、自体骨移植、长段异体骨移植重建修复股骨距的方法，用钢丝固定，或用骨水泥固定。结果32例患者均顺利通过手术，住院期间无死亡病例。住院13～22d，平均16．5d。26例获得随诊，随诊时间3～18个月，平均15个月。1例出院后3个月死于心肌梗死。24例恢复接近伤前状况，7例生活能部分自理，无感染、假体脱位、松动等情况发生。术后3个月随访X线片发现，重建的股骨距开始愈合，6个月压力骨小梁开始塑型，12个月骨小梁塑型完成，形成一个完整合理的负重系统。结论人工股骨头置换治疗老年患者股骨转子间骨折，一期修复重建股骨距的方法是可行的，且愈后功能良好。

Reconstruction of Femoral Calcar in Femoral Intertrochanteric Fractures Artificial Femoral Head Replacement for Patients

Objective To explore the reconstruction of femoral calcar in artificial femoral head replacement for femoral intertrochanteric fractures in old patients. Methods A total of 32 patients （ 24 males and 8 females） , aged 65 - 93 years （ average 74.6 years）, was performed the reconstruction of femoral calcar. Reset, fixation, auto-graft and aUograft of bone were adopted in reconstruction and repair of femoral calcar followed by fixation with steel wires or bone cement. Results All operations were successful. The period of hospitalization was 13 -22 days （ average 16.5days）. Follow up for 3 - 18 months （ average 15 months） was performed in 26 patients, one of whom died because of other disease 3 months after discharge. Twentyfau recovered near to normal and 7 could take care of themselves partially without infection, dislocation, or lose of prosthesis. Reading the X-ray reports, we could see the femoral calcar was cicatrized after 3 months. Remodeling of bone trabecular began after 6 months and accomplished after 12 months. The burden systems was restored to be integrated and reasonable. Conclusion Artificial femoral head replacement for femoral intertrochanteric fractures in old patients is feasible to reconstruct the femoral calcar in the first operation. The function can be restored to a better condition.