老年移位髋臼骨折手术治疗策略及疗效

Strategy and outcome of surgical treatment for displaced acetabular fractures in the elderly

目的探讨切开复位内固定术和一期全髋关节置换术治疗老年髋臼骨折的临床疗效并进行比较研究。方法1998～2005年间共收治45位年龄超过60岁的髋臼骨折患者，其中21例行切开复位内固定，10例行一期全髋关节置换术。手术距受伤时间不到2周，平均7d。术后常规给予抗凝药预防深静脉血栓形成，按康复计划进行恢复性功能锻炼，定期随访行髋关节功能Harris评分。结果本组随访1．5～7年，平均4年；最后随访时，切开复位内固定组Harris评分为69～84分，平均79分，优良率为57％，伴有较高的创伤性关节炎、异位骨化、股骨头骨坏死发生率；全髋关节置换术组患者的Harris评分为75～90分，平均84分，优良率为80％，仅有髋臼杯轻度移动（〈4mm），无假体松动、深部感染等并发症。结论全髋关节置换术治疗老年移位髋臼骨折可以取得比切开复位内固定更好的稳定性，术后恢复快、功能质量高，并发症少，是一种较好的选择。

Objective To compare the clinical results of open reduction and internal fixation with primary total hip arthroplasty in the treatment of displaced acetabular fractures in the elderly. Methods From 1998 to 2005, 45 patients over 60 years, with displaced acetabular fractures were treated. Among them 21 underwent open reduction and internal fixation of the fracture while 10 had primary total hip arthroplasty. The operations were performed less than 2 weeks （mean 7 days） after injury. Postoperatively, anticoagulation agents were administered routinely to prevent deep venous thrombosis and functional exercise carried out according to the rehabilitation program. Harris score of the hips was evaluated during the period of follow-up. Results All cases in this series had been followed up for 1.5- 7 years with a mean of 4 years. The latest follow-up revealed a mean Harris score of 79 （ranging from 69 to 84） in the group of open reduction and internal fixation with a relatively high incidence of complications such as traumatic oste- oarthritis, heterotopie ossification and avascular necrosis of the femoral heads. However the Harris score in the arthroplasy group was averaged 84 （ranging from 75 to 90） with only slight （ 〈4 mm） displacement of the acetabular cup but without deep infection or loosening of the prostheses. Conclusion It is good choice to treat the displaced acetabular fractures in the elderly by total hip arthroplasty, which can result in more stable hip joint with quicker and better functional recovery and less complications.