全髋关节置换术中大转子骨折原因及治疗.docVIP

全髋关节置换术中大转子骨折原因及治疗 　 作者：郭小伟，郑世军，陈金华，母心灵 摘要：目的 探讨全髋关节置换术及翻修术中股骨大转子骨折的原因与治疗方法。方法 对1996年5月至2005年1月，471髋行全髋关节置换及96 例全髋关节翻修术发生大转子骨折及大转子截骨不愈合的14 例患者进行回顾性分析。其中大转子骨折11 例，截骨不愈合3 例。2 例保守治疗，12 例采用螺钉或克氏针加张力带钢丝固定的方法治疗。结果 术后随访5～64个月，平均25个月。14 例患者全部愈合。Harris评分从术前平均48分恢复到术后随访时平均90分。结论 骨质疏松、髋内翻、髋脱位及股骨颈截骨不当等因素是全髋关节置换术及翻修术中股骨大转子骨折的主要原因。采用螺钉或克氏针加张力带钢丝固定的方法治疗效果良好。 关键词：关节成形术；髋；骨折；股骨；张力带 Causes Analysis and Treatment of Trochanteric Fractures in Primary and Revisional Total Hip Arthroplasty Abstract： Objective To investigate the main causes and treatment of trochanteric fractures in primary and revisional total hip arthroplasty. Methods A retrospective study was carried out on 14 patients(14 hips) with trochanteric fractures or trochanteric osteotomy nonunion in 471 primary total hip arthroplasty and 96 revisional total hip arthroplasty from May 1996 to January 2005. 2 cases were performed with conservative treatment， and other 12 cases were treated with screws or K wires and tension band fixation. Results The patients were followed up from 5 to 64 months with an average time of 25 months. 2 patients performed with conservative treatment healed up at 12 weeks and 16 weeks， and 12 patients treated by surgical treatment healed up at an average of 14.6 weeks. The average Harris Score improved from 48 points (before treatment) to 90 points (at last followed up). Conclusion Osteoporosis， coxa varus，coax dislocation and improper femoral neck osteotomy were the main causes of trochanteric fractures in primary or revisional total hip arthroplasty. Trochanteric fractures fixed with screws or Kwires and tension band can get excellent results. Key words： arthroplasty； hip； fracture； femur； tension band 全髋关节置换术中，因骨质疏松、髋内翻、股骨颈截骨过远等因素可能发生大转子意外骨折。转子截骨在全髋关节置换术及翻修术中有助于显露髋关节，但存在不愈合及截骨块移位的风险。大转子是髋外展肌最重要的附着部位，骨折及截骨后大转子的愈合情况与髋外展肌力量直接相关，其结果将直接影响髋关节的功能恢复［1～3］。 本院从1996年5月至2005年1月有471髋行全髋关节置换，其中7髋术中或术后发生大转子骨折，2髋大转子截骨不愈合，发生率1.9％。96 例全髋关节翻修术中有4髋发生大转子骨折，1髋发生截骨不愈合，发生率5.2％。本文通过回顾这14 例患者的临床资料，对其发生原因及治疗进行总结。 1 临