[1]吕国强,黄淑明,兰树华,等.合并慢性肾功能不全的股骨转子间骨折的治疗体会[J].中医正骨,2013,25(07):46-48.
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合并慢性肾功能不全的股骨转子间骨折的治疗体会()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第25卷
期数:
2013年07期
页码:
46-48
栏目:
髋部损伤
出版日期:
2013-07-31

文章信息/Info

作者:
吕国强黄淑明兰树华吴泉州郑荣宗郑崇武叶方
浙江省丽水市中心医院,浙江 丽水 323000
关键词:
肾功能不全慢性 髋骨折 股骨转子间骨折 骨折固定术髓内 血液透析
摘要:
的:探讨合并慢性肾功能不全的股骨转子间骨折的治疗策略。方法:在维持血液透析的基础上应用股骨近端防旋髓内钉治疗合并慢性肾功能不全的股骨转子间骨折患者17例,男12例,女5例。年龄43~92岁,中位数71岁。所有患者均为单侧新鲜闭合性骨折,左侧10例,右侧7例。骨折AO分型A1型4例,A2型11例,A3型2例。肾功能不全继发于慢性肾小球肾炎6例,慢性间质性肾炎2例,糖尿病肾病3例,高血压肾病4例,多囊肾1例,梗阻性肾病l例。血液透析史3~72个月,中位数46个月。合并其他1种内科疾病者6例,合并其他2种以上内科疾病者8例。合并肋骨骨折、肺挫伤1例,合并颧弓骨折、脑挫伤、皮肤挫裂伤1例,合并桡骨远端骨折1例,合并皮肤挫裂伤2例。术后随访观察患者的骨折愈合情况及髋关节功能。结果:本组患者手术时间35~145 min,中位数72 min; 术中出血量80~550 mL,中位数177 mL。术后1例患者发生切口感染,经加强换药及应用敏感抗生素治疗后治愈; 2例患者发生泌尿系统感染,经抗感染治疗后治愈; 3例患者肺部病情较术前加重,其中1例因病情危重治疗无效后死亡,其余2例经呼吸科会诊对症处理后改善; 1例患者术后心脏疾病加重,经心内科会诊处理后改善。术后随访期间死亡5例,其中术后第1年死亡3例,术后第2年死亡2例,死亡原因分别为心脏病发作、血栓栓塞、脑血管意外及肺部疾病加重致呼吸衰竭。术后1年存活的13例患者的骨折均达到临床愈合标准,骨折愈合时间10~22周,中位数16周。未发生内固定物松动、螺旋刀片切割股骨头、髋内翻畸形、股骨骨折及股骨头坏死等并发症。按照自报告髋关节Harris评分量表评定,患者术后1年的疼痛、坐、上下楼情况及穿鞋袜情况评分与骨折前比较,差异无统计学意义[(41.38±3.95)分,(42.00±4.00)分,t=1.477,P=0.165;(4.69±0.75)分,(4.85±0.55)分,t=1.000,P=0.337;(2.62±1.26)分,(2.92±1.04)分,t=1.000,P=0.337;(3.23±1.30)分,(3.69±0.75)分,t=1.897,P=0.082]; 术后1年的助行器使用、跛行、行走距离评分及总分低于骨折前[(6.77±3.06)分,(8.38±2.63)分,t=2.941,P=0.012;(7.62±2.99)分,(8.77±3.49)分,t=2.739,P=0.018;(7.77±2.86)分,(9.15±1.95)分,t=3.207,P=0.008;(73.46±14.98)分,(79.62±13.02)分,t=2.975,P=0.012]。结论:对于合并慢性肾功能不全的股骨转子间骨折,股骨近端防旋髓内钉是一种较有效的固定方法,而维持性血液透析改善肾功能及积极处理内科系统疾病是减少围手术期相关并发症、降低死亡率的关键。

参考文献/References:

[1] Leonard MB.A structural approach to skeletal fragility in chronic kidney disease[J].Semin Nephrol,2009,29(2):133-143.
[2] Alem AM,Sherrard DJ,Gillen DL,et al.Increased risk of hip fracture among patients with end-stage renal disease[J].Kidney Int,2000,58(1):396-399.
[3] Jadoul M,Albert JM,Akiba T,et al.Incidence and risk factors for hip or other bone fractures among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study[J].Kidney Int,2006,70(7):1358-1366.
[4] Mahomed NN,Arndt DC,McGrory BJ,et al.The harris hip score:comparison of patient self-report with surgeon assessment[J].J Arthroplasty,2001,16(5):575-580.
[5] Ureten K,Oztürk MA,Ozbek M,et al.Spontaneous and simultaneous rupture of both Achilles tendons and pathological fracture of the femur neck in a patient receiving long-term hemodialysis[J].Int Urol Nephrol,2008,40(4):1103-1106.
[6] Johal KS,Boulton C,Moran CG.Hip fractures after falls in hospital:a retrospective observational cohort study[J].Injury,2009,40(2):201-204.
[7] Nickolas TL,Leonard MB,Shane E.Chronic kidney disease and bone fracture:a growing concern[J].Kidney Int,2008,74(6):721-731.
[8] Cook WL,Tomlinson G,Donaldson M,et al.Falls and fall-related injuries in older dialysis patients[J].Clin J Am Soc Nephrol,2006,1(6):1197-1204.
[9] Schaab PC,Murphy G,Tzamaloukas AH,et al.Femoral neck fractures in patients receiving long-term dialysis[J].Clin Orthop Relat Res,1990(260):224-231.
[10] Tierney GS,Goulet JA,Greenfield ML,et al.Mortality after fracture of the hip in patients who have end-stage renal disease[J].J Bone Joint Surg Am,1994,76(5):709-712.
[11] Karaeminogullari O,Demirors H,Sahin O,et al.Analysis of outcomes for surgically treated hip fractures in patients undergoing chronic hemodialysis[J].J Bone Joint Surg Am,2007,89(2):324-331.
[12] 邱海滨,刘明礼,赵学文.股骨转子周围骨折手术相关并发症的原因和处理[J].中华骨科杂志,2008,28(3):197-201.
[13] Tosun B,Atmaca H,Gok U.Operative treatment of hip fractures in patients receiving hemodialysis[J].Musculoskelet Surg,2010,94(2):71-75.
[14] Strauss E,Frank J,Lee J,et al.Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures:a biomechanical evaluation[J].Injury,2006,37(10):984-989.
[15] Mereddy P,Kamath S,Ramakrishnan M,et al.The AO/ASIF proximal femoral nail antirotation(PFNA):a new design for the treatment of unstable proximal femoral fractures[J].Injury,2009,40(4):428-432.

更新日期/Last Update: 1900-01-01