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find Keyword "股骨转子间" 76 results
  • DESIGN AND CLINICAL APPLICATION OF LESSER TROCHANTERIC REDUCTION FIXATION SYSTEM

    ObjectiveTo design and produce a lesser trochanteric reduction fixation system and verify its value and effectiveness. MethodsA lesser trochanteric reduction fixation system was designed and produced according to the anatomical features of the lesser trochanteric fractures. Sixty-six patients with intertrochanteric fractures of Evans type Ⅲ were included between January 2010 and July 2012. Of 66 patients, 32 were treated with dynamic hip screw (DHS) assisted with the lesser trochanteric reduction fixation system (study group), and 34 cases were treated with DHS only (control group). The 2 groups were comparable with no significant difference in gender, age, the reasons, and the types of the fractures (P>0.05). The operation time, intraoperative blood loss, neck-shaft angle, bone healing time, ratio of successful fixations, and the functional evaluation of the hip joint after operation were compared between 2 groups. ResultsThe study group had shorter operation time [(58.4±5.3) minutes] and less intraoperative blood loss [(186.3±6.6) mL] than the control group[(78.5±6.2)minutes and (246.2±8.7) mL], showing significant differences (t=-14.040, P=0.000; t=-31.145, P=0.000). There was no significant difference in neck-shaft angle between study group [(138.6±3.0)°] and control group [(139.4±2.9)°] (t=-1.044, P=0.301). The wounds healed by first intention in both groups. The 30 and 31 patients were followed up 12 to 24 months (mean, 15 months) in the study group, and 13 to 25 months (mean, 16 months) in the control group, respectively. All fractures healed well in 2 groups. The study group had significantly shorter healing time [(8.8±2.0) weeks] than the control group [(10.7±3.4) weeks] (t=-2.871, P=0.006). At 12 months after operation, coxa vara happened in 2 cases of the study group with a successful fixation ratio of 93.3% and in 10 cases of the control group with a successful fixation ratio of 67.7%, showing significant difference (χ2=6.319, P=0.022). According to Harris hip score, the excellent and good rate was 83.3% in the study group (25/30) and was 58.1% in the control group (18/31), showing significant difference (χ2=4.680, P=0.049). ConclusionThe application of the lesser trochanteric reduction fixation system can reduce stripping of the soft tissue around the fracture fragments, shorten the operation time and the healing time, and preserve the function of the hip joint maximumly.

    Release date:2016-08-25 10:18 Export PDF Favorites Scan
  • BIPOLAR FEMORAL HEAD REPLACEMENT COMBINED WITH TENSION BAND WIRE FIXATION FOR INTERTROCHANTERIC FRACTURE IN ELDERLY OSTEOPOROTIC PATIENTS

    Objective To explore the effectiveness of bipolar femoral head replacement combined with tension band wire fixation for intertrochanteric fracture in elderly osteoporotic patients. Methods Bipolar femoral head replacement combined with tension band wire fixation were used for intertrochanteric fracture in 48 elderly osteoporotic patients between January 2004 and December 2010. Of 48 patients, 15 were male and 33 were female, aged 90-99 years (mean, 94.1 years). All fractures were caused by falling, and pathological fracture was excluded. It was 2-7 days (mean, 4.2 days) from fracture to surgery. According to the Tronzo Evans classification, 25 cases were rated as type IV, 20 cases as type III, and 3 cases as type II. And all of the cases were accompanied with severe osteoporosis and accompanied by more than one medical diseases, and 10 cases had spinal compression fracture. Results All patients underwent the operation successfully. Six cases died of underlying medical illness within 2 years postoperatively. A total of 39 cases were followed up 2-7 years, averaged 3.1 years. After operation, short-term mental disorders occurred in 9 cases, suspected urinary tract infection in 2 cases, sacral rear bedsore in 1 case, hip pain in 1 case, thigh pain in 1 case, and deep vein thrombosis of affected limb in 1 case. All the incisions healed by first intension, and X-ray film showed bone union in all cases; no complications of bone osteolysis, prosthesis loosening, subsidence, rupture, and heterotopic ossification occured postoperatively. No case needed revision. According to the Harris score system, the results were excellent in 5 cases, good in 28 cases, fair in 5 cases, and poor in 1 case, with an excellent and good rate of 84.6%; the score at 2 years was significantly higher than that at 6 weeks (t= — 14.79, P=0.00). The physical health score and mental health score of SF-12 at 2 years postoperatively were significantly higher than those at 6 weeks postoperatively (P lt; 0.05). The visual analogue scale (VAS) scores at 6 weeks and 2 years postoperatively were significantly lower than those at preoperation (P lt; 0.05), and the score at 2 years was significantly lower than that at 6 weeks (P lt; 0.05). Conclusion The bipolar femoral head replacement combined with tension band wire fixation for intertrochanteric fracture in elderly osteoporotic patients has the advantages of firm fixation, early function exercise with load bearing, pain relieving, improving hip function, and avoiding complication in bed.

    Release date:2016-08-31 04:08 Export PDF Favorites Scan
  • 股骨近端锁定钢板治疗股骨转子间骨折

    目的 总结股骨近端锁定钢板(proximal femur locking plate,PFLP)微创治疗股骨转子间骨折的疗效。 方法 2007 年5 月- 2008 年10 月,采用PFLP 微创治疗股骨转子间骨折24 例,并与同期采用动力髋螺钉(dynamic hip screw,DHS)治疗的32 例股骨转子间骨折患者临床疗效进行比较。两组患者年龄、性别、致伤原因、骨折分型(AO 分型)、骨质量Singh 分级、受伤至入院时间等一般资料比较差异均无统计学意义(P gt; 0.05),具有可比性。 结果 术后2 组患者切口均Ⅰ期愈合。PFLP 组患者均获随访,随访时间12 ~ 14 个月,平均12.6 个月。患者骨折均解剖复位,达骨性愈合。DHS 组30 例获随访,随访时间12 ~ 20 个月,平均13.5 个月。除3 例于术后1 个月发现未达解剖复位外,其余患者骨折均解剖复位,达骨性愈合。PFLP 组切口长度、手术时间、术中失血量、术后负重时间均优于DHS 组(P lt; 0.05),骨折愈合时间两组比较差异无统计学意义(P gt; 0.05)。 结论 PFLP 是治疗股骨转子间骨折一种适宜选择,相比DHS 具有手术创伤小、手术时间短、并发症少等优点。

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • 矩形柄人工髋关节置换治疗老年股骨转子间粉碎性骨折

    目的 总结采用矩形柄人工髋关节假体置换治疗老年股骨转子间粉碎性骨折的疗效。 方法 2008年1 月- 2010 年3 月,采用矩形柄人工髋关节假体置换治疗老年股骨转子间粉碎性骨折36 例。男16 例,女20 例;年龄75 ~ 93 岁, 平均81.2 岁。均为跌倒致伤。骨折按Evans 分型:Ⅲ型25 例,Ⅳ型11 例。均有不同程度骨质疏松,合并心血管及呼吸系统疾病26 例,糖尿病4 例。受伤至手术时间为3 ~ 9 d,平均5.4 d。 结果 术后切口均Ⅰ期愈合,无下肢深静脉血栓形成等并发症发生。 33 例获随访,随访时间12 ~ 36 个月,平均19.7 个月。 X 线片示假体位置良好,无下沉、松动、脱位、髋内翻。末次随访时根据Harris 评分标准,获优20 例,良8 例,可4 例,差1 例,优良率84.8%。 结论 矩形柄人工髋关节假体置换治疗老年股骨转子间粉碎性骨折,股骨近端骨折块成形复位容易,有良好的抗旋转作用和即刻稳定性,能维持假体的前倾角,术后卧床时间短,利于早期功能锻炼,近期临床疗效满意。

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • 动力髋螺钉加防旋拉力钉治疗股骨转子间骨折

    目的 总结动力髋螺钉(dynamic hip screw,DHS)加防旋拉力钉治疗股骨转子间骨折的疗效。 方法 2006 年1 月- 2009 年1 月,收治35 例股骨转子间骨折。男25 例,女10 例;年龄16 ~ 78 岁,平均45.2 岁。致伤原因:交通事故伤16 例,摔伤19 例。均为单侧骨折,其中左侧22 例,右侧13 例。骨折按照Evans 分型标准:Ⅰ型10 例,Ⅱ型15 例,Ⅲ型8 例,Ⅳ型2 例。受伤至入院时间为1 h ~ 6 d,平均2.3 d。入院后行患肢皮牵引,对症处理合并伤,于2 ~ 7 d后行DHS 加防旋拉力钉内固定术。 结果 术后切口均Ⅰ期愈合,无下肢深静脉血栓形成等早期并发症发生。32 例获随访,随访时间12 ~ 24 个月,平均18.6 个月。X 线片检查示32 例骨折均获骨性愈合,愈合时间为6 ~ 12 个月,平均10个月。术后12 个月根据Parker 等的评定标准评价疗效:获优24 例,良5 例,中3 例。随访期间无髋内翻、内固定物松动、双下肢不等长及患肢短缩外旋畸形等并发症发生。 结论 DHS 加防旋拉力钉可有效防止股骨头旋转,患者可早期功能锻炼,是治疗转子间骨折的有效方法之一。

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • 人工股骨头置换治疗老年不稳定型股骨转子间骨折

    目的 总结人工股骨头置换治疗老年不稳定型股骨转子间骨折的临床疗效。 方法 2006 年9 月-2008 年2 月,对22 例老年不稳定型股骨转子间骨折行人工股骨头置换。男7 例,女15 例;年龄79 ~ 95 岁,平均83 岁。跌伤14 例,交通伤8 例。骨折按Evans 分型:Ⅱ型3 例,Ⅲ型11 例,Ⅳ型7 例,Ⅴ型1 例。16 例合并骨质疏松。受伤至手术时间为3 ~ 11 d,平均6 d。 结果 手术时间平均68 min,手术出血量平均260 mL。术后切口均Ⅰ期愈合,无下肢深静脉血栓、肺栓塞等并发症发生。22 例均获随访,随访时间9 ~ 25 个月,平均14 个月。术后3 个月采用Harris 评分评定髋关节功能:获优16 例,良4 例,可2 例,优良率91%。19 例随访1 年以上未见股骨假体松动、下沉,关节脱位及假体周围骨折。 结论 人工股骨头置换治疗老年不稳定型股骨转子间骨折,尤其是粉碎性骨折伴骨质疏松者,具有术后可早期下床锻炼,减少并发症发生的优点。

    Release date:2016-08-31 05:47 Export PDF Favorites Scan
  • TREATMENT OF AGED INTERTROCHANTERIC FRACTURES WITH MINIMALLY INVASIVE DYNAMIC HIP SCREWS

    Objective To evaluate the effect of minimally invasive dynamic hip screws (MIDHS) in treating aged intertrochanteric fractures. Methods From April 2006 to March 2008, 49 aged patients with intertrochanteric fractures were treated with MIDHS. There were 22 males and 27 females, aged 65-78 years (average 70.2 years). Frature was caused by trafficaccident in 7 cases, by fall ing from height in 3 cases, and by injury from fall in 39 cases. The time from injury to operation was 2-12 days (average 5.5 days). According to Evans classification, there were 28 cases of types I, II (stable fracture) and 21 cases of types III, IV (unstable fracture). If the Singh index≤3 was defined as osteoporosis, the osteoporotic rate was 71.4% (35/49). All patients were on a radiolucent fracture traction table and their fractures had satisfactory closed reduction. After the guide wire was inserted and reamed under fluoroscopy, the lag screw and side plate were introduced through the small incision. In all unstable fractures, an additional, antirotational and large cancellous bone screw was used cranial to the DHS. Results The average operation time was 65.2 minutes. The average blood loss was 189.3 mL. All patients had satisfactory reduction and 79.6% (39/49) had adequate lag screw positions. The average postoperative hospital ization days was 5.8 days (3-12 days). All incision healed at stage I. There was no postoperative complications. Forty-nine patients were followed up 12 to 30 months (average 19.8 months). Fractures healed within 16 weeks in 47 patients and the average healing time was 13.1 weeks (12-16 weeks). The average Harris scoring was 90.8 (75-95). Implant failure and nonunion occurred in 2 cases, no serious compl ication occurred in other patients. Conclusion The MIDHS is a simple, safe and effective method for treatment of aged intertrochanteric fractures.

    Release date:2016-09-01 09:08 Export PDF Favorites Scan
  • 外固定支架在老年股骨转子间骨折的应用

    【摘 要】 目的 评价外固定支架对老年股骨转子间骨折的治疗作用。 方法 2003 年1 月- 2005 年12 月,用外固定支架治疗高龄股骨转子间骨折60 例。其中男37 例,女23 例;年龄73 ~ 95 岁,平均83 岁。骨折至治疗时间2 ~ 15 d,平均5 d,平均12 周;按AO 分型,A1 型22 例,A2 型30 例,A3 型8 例。均合并多种内科疾病而不能耐受内固定手术。 结果 外固定架操作手术时间20 ~ 40 min,平均30 min,术中无明显出血,术中及术后未输血。所有患者均获随访8 ~ 24 个月,平均18 个月。无外固定失败者。全部骨折愈合,愈合时间10 ~ 16 周,平均12 周。无死亡者。有髋内翻畸形4 例;钉道感染8 例,经口服抗生素及局部换药等处理好转,拔除外固定钉后钉道感染痊愈。髋关节功能情况按Harris 评分系统进行评分:优35 例,良22 例,差3 例,优良率95%。 结论 外固定支架治疗股骨转子间骨折具有手术安全、创伤小、失血量少等优点,是治疗老年转子间骨折的良好选择。

    Release date:2016-09-01 09:09 Export PDF Favorites Scan
  • 人工股骨头置换治疗高龄股骨转子间骨折

    目的 总结人工股骨头置换治疗高龄复杂股骨转子间骨折的早期疗效。 方法 2003 年5 月-2007 年6 月,采用双动人工股骨头置换治疗高龄股骨转子间骨折36 例。男12 例,女24 例;年龄73 ~ 92 岁,平均83岁。均为跌倒后髋部着地所致骨折。骨折至手术时间3 ~ 20 d,平均8 d。按AO 分型,A1 型3 例,A2 型25 例,A3 型8 例。 结 果 36 例患者均安全渡过围手术期。获随访6 ~ 30 个月,平均18 个月。术后X线片示假体无松动、下沉及脱位,股骨近端无骨溶解或骨吸收,未发现异位骨化。随访末期Harris 评分75 ~ 93 分,平均91 分;术后评价优20 例,良12 例,可4 例,优良率88.9%。 结论 人工股骨头置换治疗高龄复杂股骨转子间骨折近期随访效果满意,但这一术式技术要求高,应严格掌握适应证。

    Release date:2016-09-01 09:19 Export PDF Favorites Scan
  • COMPARISON OF EFFECTS BETWEEN TWO OPERATING METHODS OF TREATING INTERTROCHANTERIC HIP FRACTURE WITH GAMMA NAIL FIXATION

    Objective To evaluate the surgical efficiency of treating the intertrochanteric hip fracture with the Gamma nail fixation and to compare two operating methods of the Gamma nail fixation. Methods From August 2000 to August 2006, 69 patients (32 males, 37 females; age, 43-98 years;average, 72.3 years)with the intertrochanteric hip fracture but with no associated injury weretreated with the Gamma nail fixation. The patients’ average illness course was 5.6 days (range, 3-14 days). Among the 69 patients, 36 were treated with the traditional method of the Gamma nail fixation (Group A) and 33 were treated with animproved method of the Gamma nail fixation (Group B). According to the Association for the Study of Internal Fixation (AO-ASIF) classification, in Group A, 5 patients had a disease of Type A1, 23 of Type A2, and 8 of Type A3; inGroup B, 8 patients had a disease of Type A1, 21 of Type A2, and 4 of Type A3. The data from the two groups were analyzed, and the statistical analysis was made on the following aspects: incision length, operating time, intraoperative bleeding, X-ray exposure frequency, drainage amount, blood transfusion volume, postoperative infection of the lungs, superficial infection of the incision, duration of antibiotic use, standing with the walking stick after operation, complication due to internal fixation, healing time for the fracture, and the hip function recovery half a year after operation assessed with the Harris scoring system. Results All the 69 patients were followed up for 8-80 months(average, 42 months). We studied the indexes such as incision length, operating time, intraoperative bleeding, X-ray exposure frequency, drainage amount, and blood transfusion volum; aboveindexes in Group A were 9.5±4.7 cm, 85±35 min, 186.0±87.3 ml, 9.0±5.1 times, 102.7±49.8 ml, 325.0±169.5 ml; and those were 5.3±1.2 cm,46±10 min, 65.0±26.0 ml,3.0±2.1 times,52.5±16.2 ml,203.0± 61.2 ml in Group B. The above indexes showed that the surgical efficiency in Group B was significantly better than that in Group A (Plt;0.05). The postoperative recoveryindexes such as infection of the lungs, infection of the incision, duration of antibiotic use, standing time after operation, union time of fracture, and functionscore, were studied. There was a statistically significiant difference in lung infection, incision infection, duration of antibiotic use, and standing time after operation between Group A and Group B(Plt;0.05). Conclusion The improved method of the Gamma nail fixation fortreating the intertrochanteric hip fracture can increase the surgical efficiency and improve the patient’s early recovery after operation, especially suitable for the elderly patients who have more complications. This kind of method can shorten the operating time and the anesthesia duration, reducing the incision infection and the blood loss during operation, and decrease the frequency of the X-ray use.

    Release date:2016-09-01 09:20 Export PDF Favorites Scan
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