半髋关节置换治疗高龄患者复杂股骨粗隆间骨折

Hemiarthroplasty for the treatment of complicated femoral intertrochanteric fracture in elderly patients

目的 :探讨半髋关节置换治疗复杂股骨粗隆间骨折高龄患者的优缺点。方法 :自2013年8月至2017年1月治疗66例股骨粗隆间骨折高龄患者,男20例,女46例;年龄80~95岁,平均85岁。根据改良Evans分型,Ⅲ型33例,Ⅳ型24例,Ⅴ型9例。既往病史:高血压31例,糖尿病10例,重度骨质疏松症12例,房颤5例,肺心病3例,多发性骨髓瘤1例。采用半髋关节置换34例,内固定32例。观察比较两组患者术中及术后出血量、并发症、Harris评分。结果:术中和术后失血量:关节置换组分别为(320±20)ml和(200±25)ml,内固定组分别为(350±30)ml和(250±30)ml,两组比较差异无统计学意义(P>0.05)。所有患者获得随访,平均随访时间为2年。关节置换组Harris评分85.0±6.4高于内固定组72.0±3.4(P<0.05)。两组并发症发生情况比较差异有统计学意义(P<0.05)。结论 :股骨粗隆间骨折的高龄患者基础疾病多,预期生存期短,使用人工双极股骨头假体较内固定术可以及早及最大程度地恢复髋关节功能,使患者早期下床负重,有效降低内固定导致的并发症,提高患者生存质量及满意度,早期疗效好,是一种可以补充的治疗方式,符合快速康复外科和损伤控制理论,但不应扩大适应证,同时需加强围手术期的管理。

Objective：To discuss the hemiarthroplasty for the threatment of femoral intertrochanteric fracture in elderly patients. Methods：From August 2013 to January 2017,66 elderly patients with complicated femoral intertrochanteric fi＇acture were treated including 20 males and 46 females with an average age of 85 years old ranging from 80 to 95. According to improve Evans classification,33 eases were type Ⅲ ,24 eases were type Ⅳ ,9 eases were type V. History included 31 eases of hypertension, 10 eases of diabetes, 12 eases of severe osteoporosis, 5 eases of atrial fibrillation, 3 eases of pulmonary heart disease,and 1 ease of multiple myeloma. Hip hemiarthroplasty was used in 34 eases and internal fixation in 32 eases. The bleeding volume, complications and Harris scores of the two groups were observed and compared. Results：The amount of blood loss during and after operation were （320±20） ml and （200±25） ml in the joint replacement group, and （350±30） ml and （250±30） ml in the internal fixation group, and there was no statistical difference between the two groups （P〉0.05）. All patients were followed up for an average of 2 years. The Harris score of the joint replacement group was 85.0±6.4,which was higher than that of the internal fixation group （72.0±3.4） （P〈0.05）. The difference of complications between the two groups was statistically significant （P〈0.05）. Conclusion：The elderly patients with femoral intertrochanteric fractures have many basic diseases, and the expected survival time is short. Using artificial bipolar femoral head prosthesis can restore the hip function early and to the maximum degree, make the patients get down in the bed early, effectively reduce the complications caused by internal fixation, improve the patient＇s quality of life and satisfaction, and early treatment. It is a kind of supplemental treatment, which conforms to the theory of rapid rehabilitation surgery and injury control, but should not expand the indication and strengthen the management of the perioperative period.