关节置换治疗高龄不稳定股骨粗隆间骨折△

Hip arthroplasty for unstable intertrochanteric femoral fractures in elderly

摘要:

[目的]探讨人工关节置换治疗高龄不稳定股骨粗隆间骨折（intertrochanteric femoral fracture, ITF）的临床效果。[方法] 回顾性分析 2013 年 1 月 1 日—2023 年 12 月 31 日山东省文登整骨医院骨关节三科收治的 28 例关节置换治疗高龄不稳定 ITF 患者的临床资料，评价临床及影像结果。[结果] 所有患者均顺利完成手术，手术时间平均 （59.9±5.4） min，术中失血量平均 （269.8±76.4） mL。患者均获 6 个月以上随访。随着术后 1、3、6 个月的时间推移，VAS 评分 [(3.9±0.6), (2.1±0.4), (0.8± 0.4), P＜0.001]、Harris 评分 [(73.2±3.5), (79.3±4.6), (83.3±2.2), P＜0.001]、髋关节伸屈 ROM [(95.6±2.3)°, (113.8±5.4)°, (134.9±3.5)°, P＜0.001]、内-外旋 ROM [(63.1±7.0)°, (72.1±6.0)°, (78.6±2.5)°, P＜0.001] 均显著改善。影像方面，与术后即刻相比，末次随访时颈干角、头颈长度、前倾角，假体位置均无显著变化（P＞0.05）。[结论]关节置换治疗高龄不稳定 ITF 能取得良好效果，患者术后可尽早进行康复锻炼，减少患者痛苦。

Abstract:

[Objective] To investigate the clinical consequence of hip arhtroplasty in the treatment of unstable intertrochanteric femoral fracture (ITF) in elderly. [Methods] A retrospective study was conducted on 28 elderly patients who received hip arthroplasty for unstable ITF in our hospital from January 1, 2013 to December 31, 2023. The clinical and imaging documents were evaluated. [Results] All patients had operation performed successfully with operation time of (59.9±5.4) min and intraoperative blood loss of (269.8±76.4) mL, and were followed up for more than 6 months. With time1 month , 3 months and 6 months postoperatively, the VAS score [(3.9 ±0.6), (2.1±0.4), (0.8±0.4), P＜0.001], Harris score [(73.2±3.5), (79.3±4.6), (83.3±2.2), P＜0.001], hip extensionflexion ROM [(95.6±2.3)°, (113.8±5.4)°, (134.9±3.5)°, P＜0.001] and internal-external rotation ROM [(63.1±7.0)°, (72.1±6.0)°, (78.6±2.5)°, P＜0.001] were significantly improved. As for imaging, there were no significant changes in shaft-neck angle, head and neck length, anteversion of the femoral component at the last follow-up compared with those immediate postoperatively (P＞0.05). [Conclusion] Hip arthroplasty achieve good results in the treatment of unstable ITF in elderly, in which the patients can undergo rehabilitation exercise as soon as possible after surgery to reduce the pain.