大粗隆下移并带围领人工股骨头置换治疗老年股骨粗隆间骨折

目的 探讨大粗隆下移重建并带围领人工股骨头置换治疗老年股骨粗隆间粉碎性骨折的手术方法及疗效. 方法 回顾分析2004年5月至2009年5月收治的98例老年股骨粗隆间粉碎骨折患者,采用大机隆下移重建及带围领骨水泥型人工股骨头置换术治疗46例（试验组）;采用大粗隆复位植骨固定治疗52例（对照组）,对2组临床资料进行比较分析. 结果 2组患者在手术时间及术中出血量均无明显统计学意义（P＞0.05）.术后2组患者均获随访,随访时间12～36个月.试验组肢体缩短长度（0.5±0.2）cm]比对照组（1.7±0.2）cm]短,差异有统计学意义（P＜0.05）.按照Harris标准评定髋关节功能,试验组优良率95.6%（44/46）,对照组80.7%（42/52）,差异有统计学意义（P＜0.05）. 结论 人工股骨头置换治疗高龄股骨粗隆间骨折的临床效果良好,大粗隆下移可早期重建外展肌力臂,提供假体的早期稳定,缩短康复时间.

Treament of unstable femoral intertrochanteric fracture in elderly patients with the distal transfer of the greater trochanter in artificial femoral head replacement

Objective To investigate the operative procedure and the therapeutic effects of unstable femoral intertrochanteric fracture in elderly patients with distal transfer of the greater trochanter in artificial femoral head replacement. Methods From May 2005 to December 2008,98 elderly patients with unstable femoral intertrochanteric fracture were treated with artificial femoral head replacement.and 46 cases with distal transfer of the greater trochanter(test group)and 52 cases with fixation of femoral greater trochanter and smaller trochanter(control group). Results The operations were successful.The incision healed by first intention.There were no significant differences in operation time,operative blood loss(P ＞0.05).The two groups were followed 12 ～36 months.The test group load times are noticeably shorter than the control group,the difference was statistically significant(P ＜ 0.01).The length of the test group limb was shorter than the control group.The difference was statistically significant(P＜0.05).There were significant differences(P ＜ 0.05)in the excellent and good rate of hip function(by Harris standard)between the test group 12 months after operation. Conclusions Tne aged patients with intertrochanteric fracture can get good results through artificial femoral head replacement,and the distal transfer of the greater trochanter can reconstruct the outreach arm of the hip and provide the early stability of the prosthesis and shorten the recovery time.