股骨粗隆间骨折内固定失败后的假体置换治疗.DOCVIP

临床医学论文-股骨粗隆间骨折内固定失败后的假体置换治疗 ?????????? 作者：徐瑞生，吴洁石，薛骏，包聚良，王立邦?? 【关键词】? ,粗隆间骨折 ??? 摘? 要：［目的］探讨股骨粗隆间骨折内固定失败后采用假体置换术治疗的适应证、观察围手术期并发症、评价治疗效果。［方法］2002年1月~2004年12月收治粗隆间骨折内固定失败的患者中，8例采用股骨端特制的骨水泥型假体置换治疗。术后观察患者生活自理能力及手术并发症的发生情况。术后随访6~18个月，按照Harris标准评价手术治疗效果。［结果］手术均顺利完成，耗时约60~90 min；无骨水泥方面的并发症；术后均顺利渡过围手术期，术前疼痛症状消失，无伤口感染、假体脱位、坠积性肺炎、褥疮、下肢深静脉栓塞等并发症；随访期间未出现假体松动、断裂方面的并发症。Harris评分：优5例，良2例，中1例。［结论］粗隆间骨折内固定失败后采用假体置换术治疗，术后可以获得较好的功能恢复和生活质量提高，手术并发症少，疗效较满意。 ??? 关键词：股骨；? 粗隆间骨折；? 内固定；? 并发症；? 全髋置换 ?????? Abstract：［Objective］To explore the indication of THR reoperation for intertrochanteric fracture after internal fixation failure,as well as the complications and its effects［Method］Among intertrochanteric fracture of internal fixation failure patients during January 2001 to December 2004,eight patients were treated with special femoral prosthesis THRAfter operation they were followed up from 6 to 18 months and their selfcare ability and complications with THR operation were observed.［Result］All operations were done successfully in 60 to 90 minutes without any bone cement complicationThere were no infection,prosthesis dislocateion,hypostatic pneumonia,bed sore or deep veins thrombosis of lower limb compications and the pain in hip disappeared after operation,meanwhile neither loosening nor breaking of prosthesis was found during followup periodAccording to Harris score: 5 cases get excellent,2 cases get good and a case get general result［Conclusion］THR for intertrochanteric fracture after internal fixation failure can get a good functional recovery and elevation of life quality with few complications to meet a satisfied outcome ??? Key words：Internal fixation;? Intertrochanteric fracture;? Internal fixation;?? Complication;?? THR ??? 粗隆间骨折内固定后发生Richard钉对股骨颈和股骨头的切割作用，导致内固定失败并不罕见。早期如果能够预见内固定的问题，可以采用外固定辅助治疗，争取骨折的顺利愈合［1,2］。一旦发生内固定失败，出现骨不连、股骨头或髋臼遭主钉切割而严重破坏、出现较明显的髋部疼痛症状，则需要进行手术翻修。作者自2002年1月起探索采用股骨端假体柄较长的全髋置换(total hip replacement,THR)治疗这类患者，疗效比较满意，报告如下。 ??? 1? 资料与方法 ??? 11? 临床资料 ??? 2002年1月~2004年12