小切口微创全髋关节置换治疗老年股骨颈骨折

Total hip replacement with small incision for treating femoral neck fracture in the elderly

目的：探讨外侧小切口人路全髋关节置换治疗老年股骨颈骨折的可行性及临床效果。方法：49例股骨颈骨折，男21例，女28例；年龄60—85岁，平均70．5岁。按Garden分型：Ⅲ型15例，Ⅳ型34例。均采用外侧小切口微创全髋关节置换治疗，采用生物固定型假体13例，骨水泥固定型假体34例，杂交固定型假体2例。结果：小切口微创全髋关节置换手术切口平均长9cm（7～11cm），手术时间80～110min，平均100min，出血量200—500ml，平均325ml，术后24h引流量90～200ml，术中股骨大粗隆顶点撕脱骨折3例。本组随访6～28个月，无感染、脱位、神经损伤等严重并发症。术后早期X线片显示髋臼假体外展角40。～48。，平均44．6°；前倾角15°～20°，平均18°；骨水泥型假体周围骨水泥分布均匀；股骨假体位置良好，无内外翻表现。髋关节功能Harris评分：优35例，良13例，中1例，优良率97．9％。结论：小切口微创全髋关节置换治疗老年股骨颈骨折创伤小、术后恢复好，是一种安全可行的方法。

Objective：To discuss the feasibility and clinical effect of total hip replacement （THR） with outside small incision for treating femoral neck fracture in the elderly. Methods：Forty-nine femoral neck fractures with the age from 60 to 85 years old （21 males and 28 females） were treated with outside small incision THR. Garden Ⅲ and Garden IV were 15 and 34 respectively. Prosthesis included biological type in 13 cases, bone cement type in 34 cases and hybrid type in 2 cases. Results：The average incision length was 9 cm（7 - 11 cm） and the average operative time was 100 min ranging from 80 to 110 min, Avulsion fracture of trochanteric peak occurred in 3 cases during operation, The bleeding volum was 200 - 500 ml with the average of 325 ml and the drainage volum was 90 - 200 ml in 24 h after operation. All the eases were followed up for 6 - 28 months and there were no serious complication such as infection , dislocation, nerve injury and so on, The early X-ray after operation showed that the abduction angle of the aeetabular prosthesis was 40° -48° with the average of 44. 6° and the anteversion angle was 15° -20° with the average of 18°, The bone cement were steady distribution around prosthesis. The Harris score of hip function：35 cases were excellent result,13 good,1 fair, the rate of excellent and good was 97. 9%. Conclusion ： Total hip replacement with outside small incision has the advantages of mini injury, good postoperative recovery, which is a safe and feasible method for the treatment of femoral neck fracture in the elderly.