高龄髋部骨折改良分型对人工股骨头置换术中假体选择的指导意义

发布时间：2018-01-21 17:29

本文关键词： 高龄患者髋部骨折假体人工股骨头置换术　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:评估高龄患者髋部骨折分型及其在人工股骨头置换术的假体选择的指导作用。针对高龄患者常见的股骨颈及转子间的骨折,我们把它们统称为髋部骨折,拟定一个基于股骨距破坏程度的高龄患者髋部骨折分型。本文旨在根据我组在为不同类型髋部骨折行人工股骨头置换术时选用不同类型假体的治疗及随访结果,为今后的高龄患者髋部骨折行人工股骨头置换术的假体选择提供参考。研究方法:收集并分析我组于2012年1月～2016年10月期间共收治≥80岁的高龄患者因髋部骨折行人工股骨头置换术55例,患者年龄为80-97岁,其中男22例,女33例,平均年龄87岁,根据患者术前影像学资料显示骨折对股骨距破坏程度,把所有患者分为:A型、B1型、B2型、C型,并选用相应的股骨假体。所有患者均行人工股骨头置换术治疗,应用复查X光片观察骨折愈合情况并结合髋关节Harris评分进行随访,定期评估所有患者术后病情恢复情况及临床疗效,最后分别统计比较A型、B型(B1和B2)、C型骨折组患者手术前后Harris评分差异是否相同。结果:所有手术治疗的55例患者均获得随访,随访时间4～52个月(平均18个月),术后X片提示假体位置及角度良好,患肢较对侧基本等长,其中2例较对侧短缩1cm。总体Harris评分65～91分,平均为79.3分,优良率达到100%;3组患者术前术后Harris评分差值存在差异,差异有统计学意义(P0.01),且评分差值C型B型A型。结论:对于此类高龄髋部骨折患者,成功的人工股骨头置换术除了需要手术医生精湛的操作技术,正确选择合适的假体是其关键。因此,我们通过制定一个髋部骨折新的综合分型,只描述髋部骨折的核心关注点——股骨距完整性,给手术医生选择假体提供更直观的建议。从本次研究的患者术后恢复可见,此分型也是具有相当的可行性。
[Abstract]:Objective: to evaluate the classification of hip fracture in elderly patients and its guiding role in prosthetic selection of artificial femoral head replacement. We call them hip fractures. The purpose of this study was to select different types of prostheses for the treatment and follow-up of different types of femoral head replacement for different types of hip fractures in our group according to the classification of hip fractures based on the degree of fracture of the femur. To provide a reference for the selection of prosthesis for hip fracture replacement in elderly patients in the future. From January 2012 to October 2016, we collected and analyzed 55 cases of artificial femoral head replacement for hip fracture in our group. The age of the patients was 80-97 years old, including 22 males and 33 females with an average age of 87 years. Type B1, type B2, type C, and the corresponding femoral prosthesis were selected. All the patients were treated with artificial femoral head replacement. X-ray examination was used to observe fracture healing and Harris score of hip joint was used to follow up and evaluate the recovery and clinical effect of all patients regularly. Finally, A type was compared statistically. The difference of Harris score before and after operation in patients with type B and type B 2 fracture was the same or not. Results: 55 patients with all kinds of surgical treatment were followed up. The follow-up time was 4 ~ 52 months (mean 18 months). X ray showed that the position and angle of the prosthesis were good and the affected limb was equal to the opposite side. The total Harris score was 651.The average score was 79.3, and the excellent and good rate was 100; There was significant difference in Harris scores between the three groups before and after operation, and the difference was significant (P 0.01), and the score difference was C type B A. Conclusion: for this kind of elderly patients with hip fracture. Successful artificial femoral head replacement requires the masterly operation of the surgeon and the proper selection of the prosthesis is the key. Therefore, we develop a new comprehensive classification of hip fractures. We only describe the core concern of hip fracture, the integrity of the femoral talus, and provide more direct advice to the surgeon on the choice of prosthesis. From the postoperative recovery of the patients in this study, this classification is also quite feasible.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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