人工关节置换术治疗股骨粗隆间骨折内固定失败的老年患者

Hip arthroplasty for failed internal fixation of intertrochanteric fractures in elderly patient

  • 摘要: 目的: 报告采用人工关节置换治疗老年患者股骨粗隆间骨折内固定术后失败病例的疗效。方法: 本组13例,男5例,女8例。年龄73~88岁,平均79岁。内固定失败时间6~15个月,平均11个月。初次骨折固定方法: PFN(股骨近端髓内钉)固定5例,DHS(滑动加压鹅头钉)固定6例,短重建钉固定2例。患肢活动受限且均有明显疼痛,基本丧失行走能力,8例经常服用止痛药,5例间断服止痛药。13例均采用骨水泥型人工关节置换治疗,其中10例人工股骨头置换,3例人工全髋关节置换。结果: 全部患者均顺利通过手术。术后11例有随访结果,随访时间5~15个月,平均9个月,均可扶助行器或手杖行走,达到生活自理或大部分自理。结论: 老年股骨粗隆间骨折内固定术后失败导致骨不连或严重畸形,采用人工关节置换治疗,是一种拯救性的治疗措施,疗效满意。

     

    Abstract: Objective: To study the effective of arthroplasty for failed internal fixation of intertrochanteric fractures in the elderly patients.Methods: 13 cases(male 5 and female 8) of failed internal fixation of intertrochanteric fractures in elderly patients were treated with hip arthroplasty.The average age was 79 years old(range 73-88 years old).The average period from failed fixation was 11 months(range 6-15 months).Primary fixation methods were PFN in 6 cases,DHS in 5 cases,and short reconstructive nail in 2 cases.All the patients felt pain in the affected limbs,had limited movement of the limbs and almost lost their walking ability.All the patients were treated with cemented artificial hip joints,10 with artificial femoral head and 3 with total hip joint.Results: All operations were successful.11 were followed up for 5 to 15 months,with an average of 9 months.They could walk with the cane or other walking aid.Conclusion: Hip arthroplasty is a salvage procedure and effective for the treatment of failed internal fixation of intertrochanteric fractures in the elderly patients.

     

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