TKA治疗老年股骨远端骨折的应用分析

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摘要目的通过观察分析全膝关节置换术治疗老年股骨远端骨折的疗效，以确定该治疗方法是否可靠。方法研究包括17例股骨远端骨折患者，年龄66～87岁(平均80.2岁)，膝关节KL关节炎分级均为2级以上。均行全膝关节置换术治疗，根据术中骨缺损和韧带状况选择假体，术后早期运动和负重，通过临床状态分析和影像学观察进行随访分析。结果手术术中失血789 mL(660～1 860 mL)，手术时间78 min(57～118 min)，无围手术期死亡。随访时间0.75～4.00年(平均2.40年)，平均独立行走时间6 d(3～17 d)。末次随访时，无人工关节脱位或松动，无患者进行二次手术，平均活动度95.3°(78.4°～112.3°)，平均HSS评分83.6分(74～92分)。结论全膝关节置换是一种可行的老年股骨远端骨折治疗方法。

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关键词 ：股骨远端骨折, 老年, 全膝关节置换

Abstract：Objective To analysis the outcome of total knee replacement in elderly patients with distal femoral fracture in order to determine whether total knee replacement can be an available method.Methods In this study，17 patients aged from 66 to 87 years old (mean age as 80.2 years) with the KL arthritis grade of two or over.They were treated with total knee arthroplasty，the choice of the implant and level of constraint was determined as bone defects and ligaments status.Patients were allowed rapid mobilisation with immediate full weightbearing，then they were followed up for clinically and radiographically.Results Mean blood loss was 789 mL (660～1 860 mL)，mean operative time was 78 minutes (57～118 mins).There were no peri-operative deaths.Patients were followed up from 0.75 to 4.00 years (mean 2.4 years).The patients returned to independent walking meanly in 6 days(3～17 day).At the latest follow-up，there was no dislocation or loosening，no secondary operation，Mean ROM was 95.3° (78.4°～112.3°)，and mean HSS score was 83.6 (74～92).Conclusion Total knee replacement is a reasonable treatment of distal femoral fractures in elderly.

Key words： distal femoral fracture elderly total knee replacement

作者简介: 王春生(1970－ )，男，副主任医师，西安交通大学第二附属医院骨一科，710004。

引用本文:

王春生 1，陈富春 2，张子琦 1，杨佩 1，王坤正 1. TKA治疗老年股骨远端骨折的应用分析[J]. 实用骨科杂志, 2017, 23(6): 500-502.
Wang Chunsheng 1，Chen Fuchun 2，Zhang Ziqi 1，et al. Total Knee Arthroplasty in the Management of Diatal Femoral Fracture in Elder. sygkzz, 2017, 23(6): 500-502.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2017/V23/I6/500

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