老年人不稳定型股骨转子间骨折的治疗进展

发布时间：2018-05-07 23:13

  本文选题：股骨颈骨折 + 关节成形术　； 参考：《中国组织工程研究》2017年23期

【摘要】：背景:随着对于股骨转子间骨折的研究不断深入,股骨转子间骨折的分型也从最初的Evans分型、Boyd-Griffin分型等逐渐发展到Evans-Jensen分型以及AO/OTA分型,其分型类别对临床治疗的指导意义也各有所长。目的:就高龄患者不稳定型股骨转子间骨折的治疗进展进行综述。方法:以"Intertrochanteric Fracture""Intramedullary Nail""Hip arthroplasty";"股骨转子间骨折""髓内钉""人工髋关节置换术"为关键词。在Pub Med,Web of Science,万方,中国知网等数据库进行检索。共查阅文献1 535篇,通过阅读文献题目及摘要是否与老年患者股骨转子间骨折相关,排除文献1 488篇,最终纳入47篇文献进行分析。结果与结论:股骨转子间骨折的治疗理念从保守的卧床牵引治疗发展到现今的积极手术治疗。随着工业技术及临床水平的不断进步,其内固定物也不断改变。钉板系统由最初的Jewett板、AO/ASIF角度钢板发展到动力髋螺钉。随着髓内固定的提出,Gamma钉、股骨近端髓内钉以及股骨近端防旋髓内钉也相继产生,并在临床上取得良好的疗效。对于高龄不稳定型转子间骨折患者,积极的内固定治疗仍可获得良好疗效,但由于其骨质疏松、骨愈合能力降低或伴有退行性髋关节病变等原因,内固定后的并发症发生率也在不断上升。因此,部分学者提出使用人工髋关节置换治疗高龄患者不稳定型转子间骨折,以期获得快速地术后功能康复、较高的手术成功率以及较低的术后并发症发生率。但对于内固定和人工关节置换的选择仍存在争议。
[Abstract]:Background: with the further study of intertrochanteric fracture of femur, the classification of intertrochanteric fracture of femur has been gradually developed from the initial Evans classification and Boyd-Griffin classification to Evans-Jensen classification and AO/OTA classification. The classification of the clinical treatment of the guiding significance of each has its own strengths. Objective: to review the treatment progress of unstable intertrochanteric fracture in elderly patients. Methods: the key words were "Intertrochanteric Fracture" Intramedullary Nail "Hip arthroplasty", "intertrochanteric fracture of femur", "intramedullary nail" and "artificial hip replacement". The database is retrieved from the Pub Medpost Web of Science, Wanfang, China knowledge Web and other databases. A total of 1,535 articles were reviewed, including whether the titles and abstracts were related to femoral intertrochanteric fractures in elderly patients, 1 488 papers were excluded, and 47 articles were included in the analysis. Results & conclusion: the treatment concept of intertrochanteric fracture of femur developed from conservative bed-rest traction treatment to active surgical treatment. With the continuous progress of industrial technology and clinical level, its internal fixation is constantly changing. The nail plate system developed from the original Jewett plate / AOP / Asif angle plate to the dynamic hip screw. With the development of intramedullary fixation, intramedullary nail of proximal femur and intramedullary nail against rotation of proximal femur were produced one after another, and good curative effect was obtained in clinic. For the elderly patients with unstable intertrochanteric fracture, positive internal fixation can still obtain good results, but due to osteoporosis, reduced bone healing ability or associated with degenerative hip diseases, etc. The incidence of complications after internal fixation is also on the rise. Therefore, some scholars proposed the use of artificial hip replacement in the treatment of unstable intertrochanteric fractures in elderly patients, in order to obtain rapid postoperative functional rehabilitation, higher success rate and lower incidence of postoperative complications. However, the choice of internal fixation and artificial joint replacement is still controversial.
【作者单位】： 武汉大学人民医院骨科;
【分类号】：R687

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