骨水泥干假体联合内固定姑息性治疗高龄骨质疏松性股骨干骨折

摘要

目的 探讨采用骨水泥干假体联合内固定姑息性治疗高龄骨质疏松性股骨干骨折的方法.方法 收集2013年5月至2015年5月无锡市第二人民医院骨科收治的12例高龄骨质疏松性股骨干骨折患者资料,男性8例,女性4例,平均年龄(84.0±2.5)岁;致伤原因:摔倒伤10例,交通事故伤2例.骨折类型按照AO分型,A1型1例,A2型5例,A3型3例,B1型1例,B2型2例.手术方法采用钢板内固定加骨水泥干假体,术后进行疼痛评分、髋关节活动及行走能力评估.疼痛评分和行走能力采用配对样本t检验和秩和检验.结果 12例均获得随访,平均随访时间(16.0±3.6)个月,平均住院(9.0±1.4)d,手术时间(68.0± 10.6)min,术中出血量(106.0±24.2)ml.患者术后2周开始负重行走和活动,步态及关节活动范围逐渐恢复,肢体无明显畸形,内固定无松动.所有患者无骨折处再次移位,未见钢板和螺钉发生断裂,无肢体变形,无骨水泥反应,伤口均一期愈合.术后患髋功能采用Holden评分标准,行走能力恢复至(4.1±0.9)级,髋关节活动恢复至98.5°±7.7°,疼痛评分为(1.22±0.58)分,行走能力与术前相比差异有统计学意义(Z=-3.126,P＜0.05);疼痛评分与术前相比差异有统计学意义(t=23.047,P＜0.01).有1例患者诉患侧臀部疼痛,有2例患者诉患侧大腿疼痛,10例患者恢复至术前活动水平.术后功能恢复满意,差异有统计学意义.结论 使用内固定加骨水泥干假体支撑姑息性治疗严重骨质疏松股骨干骨折效果良好,术后患者疼痛好转,患髋功能恢复,行走能力改善.%Objective To explore the treatment of senile osteoporotic femoral fractures after using internal fixation of bone cement dry prosthetic.Methods Twelve patients aged from 74 to 94 years with mean age of (84.0±2.5) years with internal fixation of bone cement dry prosthetic surgery who were treated at Department of Orthopaedics in Nanjing Medical University Affiliated Wuxi Second Hospital between May 2013 and May 2015 were retrospectively analyzed.There were 8 male and 4 female,10 cases of tumble and 2 cases of traffic injury.The fracture types with AO type included 1 case of A1 type,5 cases of A2 type,3 cases of A3 type,1 case of B1 type,2 cases of B2 type.The steel plate internal fixation with bone cement dry prosthetic method was chosen to treat senile severe femoral fracture.Postoperative observation of postoperative pain assessment,hip joint activity and walking ability were evaluated.Paired simple t test and Wilcoxon rank sum test were used to compare the differences of pain score and the ability to walk.Results Twelve cases received an average of (16.0±3.6) months follow-up.The average hospitalization days are (9.0±1.4) days and average of intraoperative time was (68.0± 10.6) minutes.Intraoperative blood loss compared to normal was (106.0±24.2) ml.Patients began walking load and activities in two weeks.The gait and joint activities gradually restored and there were no obvious deformity and no loose internal fixation.All of the patients didn't have fracture shift with breaking plates or screws deformation and have no bone cement reaction.The walking ability was (4.1±0.9) points,the hip joint activities were 98.5°±7.7° and pain scores were 1.22±0.58 by Holden grading standards.The differences of walking ability (Z=-3.126,P＜ 0.05) and pain scores (t =23.047,P ＜ 0.001) between pre-and post-operative were statistically significant.One patient had contralateral hip pain,2 patients had lateral thigh pain,10 patients returned to preoperative level of activity.Postoperative function recovered satisfactorily,there were statistically differences.Conclusion The treatment of severe osteoporosis fractures by internal fixation with bone cement dry prosthetic is a new and effective method,making patients less pain,improving joint function and walking ability.