目的 研究外固定架固定改良技术治疗老年高风险股骨转子间骨折的临床疗效。方法 回顾性分析2014-03至2015-05治疗的30位老年高风险股骨转子间骨折患者。采用我科外固定架固定改良技术对其进行治疗。结果 28例获得随访，时间为3～14个月，平均6个月。所有患者骨折愈合良好，愈合时间为3～6.5个月，平均3.4个月。按髋关节Harris评分:26例优秀，1例良好，1例一般，0例差，优良率为96.4％(27／28)。2例发生轻微的髋内翻。无金属过敏及股骨头被螺钉切割的患者。结论 该法较传统手术，手术时间短、术中出血量少、术后骨折愈合时间短，操作简单，在治疗手术耐受力差的老年患者具有明显优势。
Abstract
Objective To research the clinical effect of modified external fixation technique for intertrochanteric fractures in high-risk elderly patients.Methods From August 2008 to December 2009, 30 high-risk elderly patients with femoral intertrochanteric fracture were treated by modified external fixation technique.The data were retrospectively analyzed.Results 28 cases were followed up successfully. The follow-up period ranged from 3 months to 14 months (mean 6 months).Fractures were healed after 3 to 6.5 months (mean 3.4 months) in 28 cases. On the basis of Harrris score, 26 cases were excellent, 1 cases were good,1cases were fair and no case was poor,so the excellent and good rate was 96.4% (27/28).In 2 cases,slight hip varus developed. In all the cases,metal sensitivity and cutting the femoral head by screw were not seen.Conclusions The advantages of the modified external fixation technique compared with traditional surgery include shorter operation time,less blood loss during operation and shorter fracture healing time. The procedure is easy .And the clinical curative effect is remarkable for high-risk elderly patients who are poorly tolerant to surgery.
关键词
股骨转子间骨折 /
体外标记 /
外固定 /
老年高风险患者
Key words
intertrochanteric fracture /
marking in vitro /
external fixation /
high-risk elderly patients
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参考文献
[1] Emilija D R,Ljiljana M D. Does early functional outcome predict 1-year mortality in elderly patients with hip fracture[J].Clin Orthop Relat Res,2013,471(8): 2703-2710.
[2] 王有存,袁改霞,袁 叶.中西医结合治疗老年股骨颈骨折31例临床观察[J].中国临床实用医学,2010,14(12):59-61.
[3] Flores L A,Harrington I J,Heller M.The stability of intertrochanteric fractures treated with a sliding screw-plate[J].J Bone Joint Surg( Br),1990,72(1): 37-40.
[4] 梁卫东,王爱军,李 军.闭合复位髓内钉固定结合Poller钉技术治疗股骨干或干骺端骨折[J].中国临床医生杂志,2016,44(1):69-71.
[5] Yousry A H,Chotai P N,El Ghazaly S A,et al.Outcomes of trochanteric external fixation for geriatric inter-trochanteric hip fractures[J]. J Orthop,2015,12 (4):174-178.
[6] 李绍良,鲁谊,滕星,王满宜.外固定结合有限切开复位内固定术治疗Chopart关节损伤效果观察[J].山东医药,2016,56(8):59-60.
[7] Abd-Almageed E,Marwan Y.Hybrid External Fixation for Arbeitsgemeinschaft für Osteosynthesefragen (AO) 43-C Tibial Plafond Fractures[J]. J Foot Ankle Surg,2015,11(6):1031-1036.
[8] 丁 强,邢庆胜,周献伟,等.单边外固定架固定治疗高危老年股骨粗隆间骨折的临床观察[J].中国骨与关节损伤杂志,2014, 29(12):1256-1257.
[9] 兰秀夫,王爱民,孙红振,等.骨科手术风险评分在260例老年髋部骨折中的应用[J].创伤外科杂志,2008,10(2):124-127.
[10] 王亚梓,王 蕾,张海生,等.股骨转子间粉碎骨折:小转子必须固定吗[J].中华创伤骨科杂志, 2004,6 (9):970-971.
[11] Andruszkow H, Frink M, Frmke C,et al.Tip apex distance, hip screw placement, and neck shaft angle as potential risk factors for cutout failure of hip screws after surgical treatment of intertrochanteric fractures[J].Int Orthop,2012, 36(11):2347-2354.
[12] Geller J A, Saifi C, Morrison T A. Tip-apex distance of intramedullary devices as a predictor of cutout failure in the treatment of peritrochanteric elderly hip fractures[J].Int Orthop, 2010,34(5):719-722.
[13] Hsueh K K, Fang C K, Chen C M, et al.Risk factors in cutout of sliding hip screw in intertrochanteric fractures: an evaluation of 937 patients[J].Int Orthop,2010,34(8): 1273-1276.
[14] 吴海山,冯明光.髋膝关节置换术后疗效评估体系[J].中华骨科杂志, 2004, 24 (8):509-512.
[15] Sun G Y , Xu L , Zhang X H ,et al.Analysis of the clinical effects of anatomical plate and combined external fixator for the treatment of the elderly intertrochanteric hip fractures[J].Zhongguo Gu Shang,2011,24 (5):374-377.
[16] 刘明安.闭合复位外固定架固定术治疗高龄股骨粗隆间骨折临床疗效分析[J].亚太传统医药,2014,10(7):87-88.
[17] 宋 斌.闭合复位外固定架固定术治疗高龄股骨粗隆间骨折的体会[J].河南外科学杂志,2013,19(4):45-46.
[18] George W. Boghdady, Safety and reliability of external fixation for basicervical and intertrochanteric fractures in high-risk elderly patients[J].Strat Traum Limb Recon, 2007,2:83-89.
[19] 冯 雪.心血管疾病患者远期生活质量和生存率的改善[J].中国医刊,2016,51(2):16-18.
[20] Tomak Y,Kacaoglu M,Piskin A,et al.Treatment of intertrochanteric fractures in geriatric patients with a modified external fixator[J]. Injury,2005,36:635-643.
[21] 高万露,汪小海.视觉模拟疼痛评分研究的进展[J].医学研究杂志,2013,42(12):144-146.
[22] 刘晓建,王 猛,刘 杰,等.右侧股骨近端骨密度测量价值的探讨[J].中日友好医院学报,2014,28(6):347-349.
[23] 黄 峻.2014年中国心力衰竭指南基本特点和内容要点[J].中国实用内科杂志,2014,34(7):662-665.
基金
武警总医院一类课题(WZ2012016):MACI技术国产化的应用基础
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