目的 探讨人工半髋关节置换术和空心螺钉内固定治疗老年PauwelsⅠ型稳定型股骨颈骨折的临床疗效.方法 回顾性分析2016年1月至2019年4月收治的126例高龄(≥75岁)股骨颈骨折患者的临床资料,其中行人工半髋关节置换术63例(A组),采用空心螺钉内固定63例(B组).比较两组患者围术期结果、髋关节功能评分及术后并发症情况.结果 组间比较,B组患者手术时间、出血量、住院时间及费用均少于A组,差异均有统计学意义(P<0.05).术后平均随访24(18～28)个月.术后髋关节功能Harris评分比较,A组患者术后第1、3、6个月均优于B组(P<0.05),而12个月以后两组间差异无统计学意义(P>0.05).A组并发症13例(20.63％),其中切口感染2例,肺部感染4例,深静脉血栓形成2例,髋关节脱位4例,肺栓塞1例;B组并发症6例(9.52％),其中肺部感染2例,深静脉血栓形成2例,股骨头坏死2例;B组并发症发生率明显低于A组,差异有统计学意义(P<0.05).结论 对于老年(年龄≥75岁)PauwelsⅠ型稳定型股骨颈骨折患者,人工半髋关节置换术和空心螺钉内固定术均可有效恢复髋关节功能,改善患者的生活质量.人工半髋关节置换术早期改善患者髋关节功能更具有优势,并能尽早活动肢体和部分负重,而对于术前一般情况较差,麻醉风险较高,且对术后早期功能要求不高的高龄患者,可以选择空心螺钉内固定.

Objective To evaluate the residual limb lengthening and compression fixation using oblique pins after two-segmental osteotomy to treat massive infectious defect of the tibia.Methods From January 2005 to January 2012,we treated 35 patients with massive infectious tibial defect.They were 26 men and 9 women,aged from 25 to 71 years (average,43 years).Sequestra exposure was found in 15 cases and pus discharge in 12.After excision of the infectious segments,the tibia was shortened by 11.2 cm on average (range,from 8 to 21 cm).After full thickness sequestra excision,thorough debridement and irrigation,the defects of bone and soft tissue were treated by two-segmental osteotomy,residual bone lengthening and compression fixation using oblique pins.External fixation was removed after bone union.The Paley scoring system for healing of bone infection was used to evaluate the treatment outcomes.Results The 35 patients were followed up for an average of 33 months (range,from 21 to 70 months).The rate of bone lengthening was 0.67 mm/d respectively for the 2 bone segments and 1.34 mm/d for the entire tibia.The wounds healed after an average time of 25 days (range,from 15 to 68 days).Bone lengthening lasted from 2.5 to 5.6 months (average,2.8 months).Compared with one-segmental lengthening,two-segmental lengthening was faster by 3 to 6 months (average,4.7 months).Osseous healing was achieved after 25 months on average (range,from 15 to 37 months).All the patients obtained fracture union with no recurrent infection,fine alignment of the affected lower limb,and isometry between the 2 lower limbs.All cases were excellent by the Paley scoring system.Conclusion To treat massive infectious defect of the tibia,the residual limb lengthening and compression fixation using oblique pins after two-segmental osteotomv can reduce patients' pain and shorten treatment cycle,leading to complete cure of infectious bone defects.