小切口骨水泥双极人工股骨头置换治疗老年移位股骨颈骨折临床分析

Small Incision Cement Bipolar Hemiarthroplasty for Displacsd Femoral Neck Fracture in the Elderly

目的观察小切口骨水泥双极人工半髋关节置换治疗老年移位股骨颈骨折的临床疗效，为临床选择更为合理的假体构型。方法在2004年6月至2008年12月间，应用骨水泥双极人工股骨头置换治疗老年（年龄67～89岁）移位股骨颈骨折67例，Garden分型：Ⅲ型56例，IV型11例。取髋前外侧（改良Hardinge切口）手术人路，平均手术时间约45min，常规输血200ml。术后加强对患肢活动和负重情况的监察及指导。结果随访15～85个月，平均38个月。根据改良Harris评分系统，术后36个月平均为92分，60个月为89分，无髋关节脱位及明显髋股部疼痛病例。结论小切口骨水泥双极人工股骨头置换术符合老年的骨质特点，初始稳定性良好。手术时问短，创伤和风险小，术后中短期并发症发生率低，不失为一种治疗老年股骨颈骨折的良好疗法。

Objective To observe the clinic effect of cement bipolar hemi arthroplasty for displacsd femoral neck fracture in the elderly, and choose more rational configuration of prosthesis for clinic. Methods From Jun. 2004 to Dec. 2008.67 elderly patients （Age 67-89 years old）with displaced femoral neck fracture were operated by the cement bipolar hemiarthroplasty. There were 56 patients in Garden Types Ill and 11 patients in Garden Types. All expose the fracture through the Hardinge incision. The mean operating time was 45 minutes and routine transfuse 200 ml. Activity and loading status were supervised and emphasized after the operation. Results Follow-up for 15 to 86 months（ mean 38 months）. According to Modified Harris＇ scoring system, the average score was postoperative 36 months 92,60 months 89. There was no case of hip dislocation or pain of hip and thigh obviously. Conclusion The hip hemiarthroplasty is consistent with the sclerotin feature of old age and the incipient stability is good. The operating time is short, the trauma and risk is little. The complication inci- dence rate of the short and mediate time is low after operation. It can still be considered a good therapy well to displacsd femoral neck fracture in the elderly.