老年患者非稳定性股骨粗隆间骨折人工股骨头置换术

Treatment of unstable femoral intertrochanteric fracture in elderly patients (over 85 years) with artificial femoral hemiarthroplasty

目的:报告应用人工股骨头置换治疗85岁以上患者股骨粗隆间骨折的指征及疗效。方法:本组28 例,男9例,女19例。年龄85～96岁,平均88岁。均为新鲜粉碎性骨折。用气管插管全麻,心电监护。术中尽量 保留股骨粗隆部位较大的骨折块,尤其是股骨大、小粗隆复位后要用钢丝固定。先用假体试模测试前倾角认为合 适后再插入人工关节。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,保留2～3d。 结果:28例患者均顺利通过手术,术后无切口感染、血肿等并发症。住院期间无死亡病例。术后下床时间2～11d, 平均5d。住院时间16～27d,平均21d。19例出院后得到随诊,随诊时间3～36个月,平均12个月。除1例因 其它疾病于术后6个月死亡外,其余患者均在术后1个月达到生活部分自理。结论:85岁以上患者股骨粗隆间骨 折不适合其它内固定方法时,采用人工股骨头置换是行之有效的方法。

Objective:To report the indications and result of treatment of unstable femoral intertrochanteric fracture in elderly patients over 85 years old with artificial femoral head. Methods:There were 28 cases in the grouq, 9 male and 19 female, aged 85～96 years with an average of 88 years. All were fresh communited fracture injured slipping accidentally. For the sake of safety, all patients were generally anethetized and cardio-electrographically monitored. Special attention should be paid to the preservation of larger peri-trochanteric fragments during the operation and the fragments can be fixed with steel wires. The femoral antegrade angle should be referenced to the femoral condylar plane with the template. Bone defects were stuffed with bone cement. The insertion of the gluteus medius muscle should not be separated from the the greater trochanter. Suction drainage was maintained for 2 to 3 days. Results:All operations were successful. The period of hospitalization was between 16 to 27 days with an average of 21 days. 19 patients were followed up for 3 to 24 months with an average of 12 months after discharged from the hospital. 1 patient died of other diseases 6 months . The other patients recovered and could take care of themselves partially 1 month after the operation. Conclusion:It's an effective method to treat the unstable intertrochanteric fracture severely communited unsuitable for alternative internal fixation in elderly patients over 85 years.