90岁以上非稳定性股骨转子间骨折患者人工股骨头置换术

Artificial femoral head replacement for unstable femoral intertrochanteric fractures in over 90 years old patients

目的探讨采用骨水泥型双动人工股骨头置换治疗90岁以上股骨转子间骨折患者的疗效。方法本组11例,男3例,女8例;年龄90～96岁,平均93岁。骨折按Evans分类,ⅢA型6例,ⅢB型5例。取髋关节后外侧切口,术中注意保留股骨大、小转子部位的骨折块,争取将其重新复位,用钢丝固定。由于股骨颈及股骨距骨缺损,在插入人工股骨柄之前可用试模测试。股骨距部位的骨缺损用骨水泥充填重塑,关节腔内置负压引流管。本组8例患者输血200～600ml,平均400ml。若患者一般情况允许,术后1d即可在有人保护下离床站立,2～3d可扶助行器活动。结果11例患者均顺利通过手术,住院期间无死亡病例。5例曾出现老年反应性精神障碍,1例患肢发生轻度深静脉炎,经过对症治疗,至出院时基本治愈。住院16～28d,平均20d。9例获得随诊,随诊时间3～18个月,平均8个月。4例恢复接近伤前状况,4例生活能部分自理,无感染、假体脱位、松动等情况发生。1例出院后6个月死于其他疾病。结论人工股骨头置换治疗90岁以上患者股骨转子间骨折,操作可行,疗效满意,可降低死亡率、改善生活质量、减轻家庭生活护理负担。

Objective To report the indications and treatment results of artificial femoral head replacement for femoral intertrochanteric fractures in over 90 years old patients. Methods There were 11 cases (3 males and 8 females), aged 90 96 years (average 93 years). According to the fracture classification of Evans, there were six cases with type ⅢA and five with type ⅢB fractures. During posteriolateral incision into hip, fractured fragments of large trochanter and minor trochanter should be preserved during the operation so that the fragments could be fixed with steel wires. A model could be used before insertion of artificial femoral shaft because of the defects of femoral neck and femoral calcar. Bone defects in the femoral calcar were stuffed with bone cement and suction drainage maintained for 2 3 days. During the operation, eight cases received blood transfusion for 200 600 ml (average 400 ml). According to the patient's general conditions, a protected ambulation with aid could do 1 3 days postoperatively. Results All operations were successful. Of all, 5 cases showed psychological disorders post operation and gradually recovered after appropriate treatments. Slightly deep venous thrombosis occurred in one case who recovered until discharge. The period of hospitalization was 16 28 days (average 20 days). Follow up for 3 18 months (average eight months) was performed in nine cases, of which one died of other diseases six months after discharge, four recovered near to normal and four could take care of themselves partially with no infection, dislocation, or looseness of prosthesis. Conclusions Artificial femoral head replacement for femoral intertrochanteric fractures in over 90 years old patients is a feasible and effective alternative that can decrease mortality, improve life quality and relieve the burden of nursing.