半髋置换治疗高龄股骨转子间骨折的效果

Hemi-hip prosthesis replacement treatment for femoral intertrochanteric fractures in elderly patients

目的评估半髋置换治疗高龄股骨转子间骨折的临床疗效。方法2000年1月～2005年3月采用骨水泥型半髋置换治疗高龄股骨转子间不稳定性骨折20例。年龄80～95岁,平均85岁,新鲜骨折15例,内固定失败5例。取后外侧切口,保留大小粗隆部位骨块,将其复位,钢丝固定,切断股骨颈,取出股骨头,插入股骨柄,安放人工股骨头,观察住院时间、术中出血量、术后行走负重时间、并发症及死亡率。随访1～6年,平均2.1年。结果平均住院24d,术中输血量480ml,术后1周均能扶助行器行走,术后14～28d(平均20d)能完全负重行走,术后3～6个月肢体功能恢复到伤前水平,无一例死于术后并发症。随访期内假体无脱位,髋臼无明显磨损。Harris髋关节功能评分:优5例,良10例,可4例,差1例。优良率75%。结论对于80岁以上有严重骨质疏松的股骨转子间不稳定型骨折,采用半髋置换治疗,效果良好,可早期下床活动,减少并发症,降低死亡率,提高生活质量。

Objective To evaluate the clinical effect of treatment of the femoral intertrochanteric fractures with hemi-hip prosthesis replacement in elderly patients. Methods Twenty cases with unstable femoral intertrochanteric fractures of over 80 years old underwent cemented hemi-hip prosthesis replacement. The mean age was 85 （ranging from 80 to 95）. All patients had some degree of osteoporosis and other function disorders. 15 cases were fresh fracture, the other 5 were nonunion fracture after internal fixation failure. Fractured fragments of large trochanter and minor trochanter preserved during the operation so that the fragments can be fixed with steel wires and insertion of artificial femoral head. The surgical approach and operative technique, the average course of treatment, the average time to ambulate with full-weight bearing on the operated limb after the operation, complication and mortality were observed. The mean follow-up was 2 years and 1 months （ranging from 1 to 6 years）. Results The average course of stay at hospital was 24 days. The average time to ambulate was 20 days. No patients died for operative complication. There were no radiographie evidence of acetabular wear and prosthesis dislocation during the follow-up. According to Harris evaluation, 5 cases were rated as excellent, 10 good, 4 fair, and 1 poor. Conclusions For elderly patients with unstable femoral intertrochanteric fracture, especiall with extensive osteoporosis, hemi-hip prosthetic replacement may be the better choice than internal fixation in the adraneage of earlier functional recovery and lowering complications.