加长柄股骨头置换治疗固定失败的粗隆间骨折

目的探讨加长柄股骨头置换治疗内固定失败的高龄骨质疏松股骨粗隆间骨折的疗效，总结该治疗方法的临床经验。 方法2013年1月至2017年12月江门市新会区人民医院收治了l8例股骨粗隆间骨折内固定术后失败的患者，采用加长柄人工股骨头置换手术治疗，观察患者髋关节功能康复情况。纳入标准：年龄≥70岁；外伤引起股骨粗隆间骨折行内固定手术治疗后；影像学证实为粗隆间骨折内固定失败者。排除标准：有明显手术禁忌证；原骨折为肿瘤等病理性骨折；阿尔茨海默症或沟通障碍。Harris评分用于评定患者髋关节功能恢复，以术前术后Harris评分，假体松动、假体周围骨折、关节脱位等为随访内容，评分数据行t检验分析。 结果术后随访平均(16±4)个月，髋部疼痛消失或明显减轻，功能改善，均可辅助下步行活动，Harris评分由术前平均(34±3)分提高至术后12个月的(83±3)分，差异具有统计学意义(t ＝40.563，P <0.05)。 结论加长柄人工股骨头置换是治疗骨质疏松患者股骨粗隆间骨折内固定失败后的有效治疗方法，疗效满意，术后可以获得较好的功能恢复，减少卧床时间，提高生活质量。

Long-stem femoral head replacement in treatment of porotic femoral intertrochanteric fracture following failed internal fixation

Objective To investigate the therapeutic effect of long-handled femoral head replacement in the treatment of elderly osteoporotic femoral intertrochanteric fractures after the failure of internal fixation,and summarize the clinical experience of this treatment method.Methods From January 2013 to December 2017,in Xinhui People's Hospital,18 patients who failed in the internal fixation of the femoral intertrochanteric fractures were treated with long-stem artificial femoral head replacement surgery.Inclusion criteria:age≥70 years,intertrochanteric fracture of trauma with failed internal fixation confirmed by radiography.Exclusion criteria:contraindications of surgery,pathological fractures,Alzheimer's disease or communication difficulties.Harris score was used to evaluate the recovery of hip joint function.The preoperative and postoperative scores were compared by t test.The femoral stem loosening,femoral stem fracture,and hip dislocation were also observed and recorded during the follow-up.Results The patients were followed up for(16±4)months in average.the pain was disappeared or was significantly relieved,and the function was improved that the patients could walk under assistance.Compared to the preoperative scores,the difference was statistically significant in postoperative Harris score(83±3)(t=40.563,P<0.05).Conclusion Long-stem artificial femoral head replacement is an effective therapy for the patients with osteoporosis intertrochanteric fracture after the failure of internal fixation,which shows satisfactory effect,less rest time in bed,better functional recovery and improvement of the quality of life.