小切口微创髋关节置换术治疗高龄髋部骨折

Minitraumatic Hip Replacement For Hip Fracture in Aged Patients

目的：探讨小切口微创髋关节置换治疗高龄髋部骨折的可行性及结果。方法：自2003年1月～2006年2月，采用Hading入路切8cm切口，微创为25例高龄患者（85岁以上）进行髋关节人工关节置换术，男20例，女5例，年龄86～94岁，平均90岁。股骨颈GardenⅡ型7例，GardenⅢ-Ⅳ型15例，粗隆间骨折Evan分型Ⅳ型3例，均采用Plus公司的假体及工具完成手术，观察手术时间，术中出血量、切口长度、术后住院天数以及精神状态和并发症。结果：全部病例随访6～25个月，小切口对髋关节局部解剖、生物学环境干扰小，平均手术时间50min，围手术期出血量、引流量平均200ml，平均住院2周，术后2～4d有3例出现一过性精神障碍，1例深静脉炎发生，术后平均2d下地。结论：小切口微创技术可选择性的用于高龄髋部骨折人工关节置换术。其创伤小、围手术期出血少，切口仅为8cm，并不影响关节假体的置换及位置，术后早期下地疼痛轻、功能恢复快。对高龄老人精神状态变化、睡眠活动定型的“颠倒黑白”应该有良好的心理安慰与治疗。积极的预防性的开展一般抗凝、机械抗凝、药物性抗凝综合抗凝治疗，提高高龄髋部骨折置换术后治疗效果。

objective： To explore the feasibility and outcomes of minitraumatic hip arthroplasty（MIS THA） in treating hip fracture in aged patients. Methods： From Jan 2003 to Feb 2006, 25 aged patients perform MIS THA. The mean age of patients was 90 years （ranged from 86 to 94 years） .The operative time, bleeding vol- ume, length of incision, postoperative hospital day and mental condition and complications were observed. Results： Followed up between 6 to 25 months, minimal incision had less influence in anatomic recovery of hip ioint. The average hospital day was 2 weeks, the average operative time was 50 mins, Perioperative bleedins volume was 200 ml. There was mental disorder in 3 patients and deep phlebitis in patients at 2 to 4 day after operation. The average time of beginning functional exercise was at 2 day after opration. Conclusion： Selective MIS THA refers to hip replacement of hip fracture in aged patients, with minitrauma, less perioperative bleeding and rapid recovery of function.