本文選題：股骨頸骨折 + 關(guān)節(jié)成形術(shù)��； 參考：《中國組織工程研究》2017年23期

【摘要】：背景:隨著對于股骨轉(zhuǎn)子間骨折的研究不斷深入,股骨轉(zhuǎn)子間骨折的分型也從最初的Evans分型、Boyd-Griffin分型等逐漸發(fā)展到Evans-Jensen分型以及AO/OTA分型,其分型類別對臨床治療的指導意義也各有所長。目的:就高齡患者不穩(wěn)定型股骨轉(zhuǎn)子間骨折的治療進展進行綜述。方法:以"Intertrochanteric Fracture""Intramedullary Nail""Hip arthroplasty";"股骨轉(zhuǎn)子間骨折""髓內(nèi)釘""人工髖關(guān)節(jié)置換術(shù)"為關(guān)鍵詞。在Pub Med,Web of Science,萬方,中國知網(wǎng)等數(shù)據(jù)庫進行檢索。共查閱文獻1 535篇,通過閱讀文獻題目及摘要是否與老年患者股骨轉(zhuǎn)子間骨折相關(guān),排除文獻1 488篇,最終納入47篇文獻進行分析。結(jié)果與結(jié)論:股骨轉(zhuǎn)子間骨折的治療理念從保守的臥床牽引治療發(fā)展到現(xiàn)今的積極手術(shù)治療。隨著工業(yè)技術(shù)及臨床水平的不斷進步,其內(nèi)固定物也不斷改變。釘板系統(tǒng)由最初的Jewett板、AO/ASIF角度鋼板發(fā)展到動力髖螺釘。隨著髓內(nèi)固定的提出,Gamma釘、股骨近端髓內(nèi)釘以及股骨近端防旋髓內(nèi)釘也相繼產(chǎn)生,并在臨床上取得良好的療效。對于高齡不穩(wěn)定型轉(zhuǎn)子間骨折患者,積極的內(nèi)固定治療仍可獲得良好療效,但由于其骨質(zhì)疏松、骨愈合能力降低或伴有退行性髖關(guān)節(jié)病變等原因,內(nèi)固定后的并發(fā)癥發(fā)生率也在不斷上升。因此,部分學者提出使用人工髖關(guān)節(jié)置換治療高齡患者不穩(wěn)定型轉(zhuǎn)子間骨折,以期獲得快速地術(shù)后功能康復、較高的手術(shù)成功率以及較低的術(shù)后并發(fā)癥發(fā)生率。但對于內(nèi)固定和人工關(guān)節(jié)置換的選擇仍存在爭議。
[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.
【作者單位】： 武漢大學人民醫(yī)院骨科;
【分類號】：R687

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