目的：探讨人工关节置换治疗高龄股骨转子间骨折锁定解剖钢板内固定失效的临床效果。方法回顾性分析2012年3月至2014年6月西安交通大学医学部附属红会医院收治的13例股骨近端锁定钢板内固定失效的高龄股骨转子间骨折患者的临床资料，均采用人工假体置换治疗，其中双极头置换10例、全髋关节置换3例。记录手术时间、出血量、下地负重时间等指标，随访期间观察并发症发生情况，术后10个月采用Harris评分标准对患髋关节进行功能评定。结果13例患者均顺利完成手术，手术时间（85±8）min、出血量（168±21）mL、下地负重时间（23±5）d。随访时间10～24个月（平均11个月）。随访期间无感染，关节脱位、松动，假体周围骨折并发症发生；患者髋部疼痛消失或明显减轻，均可扶助行器或手杖活动；术后10个月髋关节Harris评分为（89.0±2.1）分，较术前的（39.3±1.9）分明显提高，两者比较，差异有统计学意义（P＜0.05）。结论人工关节置换是高龄股骨转子间骨折锁定解剖钢板内固定失效患者较好的治疗选择，具有明显缓解疼痛症状、显著改善髋关节功能、并发症轻微等特点。%Objective To evaluate clinical effects of arthroplasty for failed internal fixation of aged intertrochanteric fracture patients with locking anatomic plate. Methods From March 2012 to June 2014, 13 elderly patients with intertrochanteric fracture, suffered from fixation failure of proximal femoral locking plate, performed arthroplasty (including bipolar artificial femoral head replacement in 10 patients and total hip replacement in 3 patients) in Xi'an Red Cross Hospital Affiliated to College of Medicine, Xi'an Jiaotong University, their data were retrospectively analyzed in this study. Operative time, estimate blood loss, weight bearing time were recorded, complications during the follow-up were observed, and hip joint functions were evaluated according to Harris scoring criteria. Results All patients underwent the operation smoothly. The average operative time was (85 ± 8) min, estimate blood loss was (168 ± 21) mL, and weight bearing time was (23 ± 5) d. The follow-up time was 8-24 months (average, 11 months). During the follow-up, there were no complications such as infection, joint dislocation or prosthetic loosening, periprosthetic fracture; Pain was relieved significantly, and patients could walk with cane or other walking aids later; Harris score improved from preoperative (39.3 ± 1.9) to (89.0 ± 2.1) at 10 months postoperatively (P<0.05). Conclusion Hip arthroplasty is a good choice for failed fixation of aged intertrochanteric fracture patients with locking anatomic plate, because it has the advantages of hip joint functional improvement, good pain relief and less complications.
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