人工股骨头假体置换治疗高龄股骨转子部骨折的特点

Artificial replacement of the femoral head for femoral intertrochanteric fractures in the elderly

目的:观察人工股骨头假体置换对75岁以上股骨转子间骨折患者的治疗效果,以及治疗过程中的早期并发症和不良反应。方法:选择解放军总医院骨科2001-06/2005-12收治的75岁以上股骨转子间骨折患者98例(100髋),患者或家属知情同意。骨折按照EVANS分型:Ⅱ型12髋,Ⅲ型53髋,Ⅳ型32髋。全麻或硬膜外麻醉下手术,术中复位大、小转子骨折块,以钢丝固定,股骨距部位骨缺损以骨水泥充填,重塑股骨距,人工股骨头(北京京航公司或Link公司,钛合金股骨头)以骨水泥固定。复位后中立位或稍内收屈曲90°及伸直位外旋90°无脱位,认为关节安装合适。关节腔内置负压引流管。注意围手术期处理,术后患者早期下地功能锻炼。人工股骨头置换的疗效评估标准:疼痛完全消失、关节功能好、恢复生活自理者为优;活动时髋部或大腿有轻微疼痛、基本恢复生活自理者为良;活动时髋部或大腿疼痛,但可扶拐行走、生活部分自理者为可;髋部疼痛明显、不能行走、生活基本不能自理者为差。结果:98例患者中术后住院期间死亡1例;随访过程中死亡2例,原因与手术无关;失访3例,进入结果分析共92例。①术后随访6-24个月,其中6-12个月23例,13-18个月48例,19-24个月21例,平均13个月。按照疗效评估标准,优30例,良45例,可16例,差1例,优良率为82%。②术后发生早期并发症15例,包括肺部感染、深静脉血栓形成等,发生率为16%。结论:人工股骨头假体置换治疗75岁以上股骨转子间骨折患者,术后髋关节活动功能恢复率较高,并发症发生率较低。

AIM： To evaluate the clinical effect of artificial femoral head replacement on the treatment of unstable femoral intertrochanteric fracture in patients over 75 years old, and explore the early complications and adverse effects during procedure. METHODS： From June 2001 to December 2005, 98 cases （100 hips） of femoral intertrochanteric fractures aged over 75 years were selected from the Department of Orthopaedics, General Hospital of Chinese PLA. The informed consent was obtained from the patients or their family. There were 12 hips in type Ⅱ, 53 in type Ⅲ and 32 in type Ⅳ according to the EVANS classification of intertrochanteric fractures. Under general anesthesia or epidural anesthesia, the greater and lesser trochanters were reduced and fixed by wire, and the bone defects of femoral calcar were filled with bone cem＇ent; after remodeling femoral calcar, the cemented artificial femoral head of titanium alloy provided by Beijing Jinghang Corporation or Link Company was inserted into the medullary cavity of the proximal femur. The fixing was suitable if there was no dislocation under neutral position or slight adduction flexion 90° and external rotation 90° at strengthening position. Negative pressure drainage was put in the joint cavity. Postoperational functional exemise was performed eadier and perioperative management was also emphasized. The evaluation ~criteria for the curative effect of replacement were as follows： Excellent if there was no pain, joint function was good, and the living ability was recovered; Better if slight pain was felt in hip or thigh under activity, and the living ability was nearly recovered; Good if the hip or thigh felt pain under activity, walking by crutch, and part of living ability was recovered; Bad if there was obvious pain in hip, unable to walk or self care. RESULTS： One of 98 patients died in hospitalization; 2 died during follow-up, which was not associated with operation; 3 were lost for follow-up, finally 92 cases were involved in the result analysis. （1）Cases were followed up for 6-24 months with the average time of 13 months, during which there were 23 for 6-12 months, 48 for 13-18 months, and 21 for 19- 24 months. The evaluation of curative effect showed that there were 30 excellent, 45 better, 16 good and 1 bad; the excellent rate was 82%.（2）Early posteroperative complications appeared in 15 cases such as pulmonary infection, lower limbs deep venous thrombosis, etc. The incidence rate of complications was 16%. CONCLUSION： It is an effective method to treat the aged patients with femoral intertrochanteric fractures by artificial femoral head replacement; after operation, the restoration rate of joint function is high, and the incidence of postoperative complications could be decreased.