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首页> 外文期刊>European Journal of Orthopaedic Surgery & Traumatology >Press-fit hemiarthroplasty for elderly with femoral neck fracture: high complication rates in operations performed by younger surgeons
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Press-fit hemiarthroplasty for elderly with femoral neck fracture: high complication rates in operations performed by younger surgeons

机译：压入式股骨头置换术治疗老年股骨颈骨折：年轻外科医生进行手术的高并发症发生率

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摘要

Press-fit un-cemented hemiarthroplasty used in the treatment of elderly osteoporotic patients with femoral neck fracture requires technical skills in order to avoid iatrogenic complications. This study was performed in order to correlate the complication rate and the grade of the operating surgeon (middle-grade residents as compared to consultants). In this comparative retrospective study, 75 consecutive patients (mean age 80.5 years) were treated for displaced intra-capsular fracture of the neck of the femur with a hydroxy-apatite-coated (HAC) Furlong bipolar hip press-fit hemiarthroplasty. Residents performed the operation without supervision in 50 cases and in the remaining 25 patients, senior colleagues (consultants) performed the operation. The following complications were encountered; ten intra-operative and two postoperative pertrochanteric proximal femoral fractures, two cases of prosthetic loosening, one case of deep wound infection and one case of dislocation of the prosthesis. Re-operation rate was 9% revision (two for loosening, two for early postoperative pertrochanteric fracture and one for infection and one for dislocation). The complications, the intra-operative blood loss and operative time was higher in the hands of junior surgeons. Furlong HAC prosthesis hemiarthoplasty in the elderly was found to be associated with significant technical problems in the hands of junior as compared to the senior colleagues. Inadequate or overzealous reaming of the greater trochanter in order to accommodate the lateral fin of the Furlong press-fit prosthesis in our experience was the main reason for the high incidence of pertrochanteric fractures in this series. Unlike younger patients, osteoporotic patients have a lower threshold for pertochanteric fracture when press-fit prosthesis is used. Training the junior surgeons, the change of design of the press-fit prosthesis and the availability of a wide range of sizes are helpful hints reducing the complication rate. We suggest changing the current design when used in elderly.
机译：用于治疗老年股骨颈骨折的骨质疏松患者的压入式无骨水泥半髋置换术需要技术技能，以避免医源性并发症。进行这项研究是为了使并发症发生率与手术医生的等级相关（与咨询师相比，中级居民）。在这项比较性回顾性研究中，采用羟基磷灰石涂层（HAC）Furlong双极髋关节压入式半髋置换术治疗了75例连续患者（平均年龄80.5岁），以治疗股骨颈移位的囊内骨折。居民在没有监督的情况下进行了手术，其中50例，其余25名患者中，高级同事（顾问）进行了手术。遇到以下并发症；术中股骨转子周围骨折10例，术后股骨近端骨折2例，假体松动2例，深部伤口感染1例，假体脱位1例。再次手术率为9％修订（两次为松动，两次为术后股骨粗隆早期骨折，一次为感染，另一位为脱位）。初级医生手中的并发症，术中失血量和手术时间较高。与高级同事相比，老年人的Furlong HAC假体半髋置换术与大三手的重大技术问题有关。根据我们的经验，为了适应Furlong压入式假体的外侧鳍，大转子的扩孔不足或过分热情是该系列高转子转子骨折发生率高的主要原因。与年轻患者不同，当使用压入式假体时，骨质疏松患者的股骨转子狭窄的阈值较低。培训初级医生，更改压入式假体的设计以及提供各种尺寸的工具有助于降低并发症发生率。我们建议在老年人中使用时更改当前的设计。

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