保留和重建股骨距的人工股骨双动头置换治疗高龄患者不稳定股骨粗隆间骨折

Hip hemiarthroplasty with bipolar prosthesis by retaining or reconstructing calcar or lesser trochanter:Safe and effective for unstable intertrochanteric fracture in aged patients

目的高龄患者股骨粗隆间骨折是有一定治疗难度的疾病,文中旨在评价人工股骨双动头置换术对治疗高龄患者股骨粗隆间不稳定型骨折的疗效。方法对36例80岁以上股骨粗隆间骨折合并股骨距或小粗隆移位的高龄患者施行人工股骨双动头置换术,采用保留或重塑股骨距和小粗隆的方式,回复股骨粗隆部内侧稳定结构,通过Harris评分等标准对疗效进行评价。结果术后3个月复查患者X线片,与术后比较未见差异。Harris评分:优12例,良19例,中3例,差2例。结论人工股骨双动头置换术对治疗股骨粗隆间骨折合并股骨距或小粗隆移位的高龄患者是安全有效的,但要求同时重建股骨距和小粗隆。

Objective Intertrochanteric fracture of the aged patients remains a challenge to orthopedic surgeons in their selection of surgical approaches.This study aimed to evaluate the clinical effect of hip hemiarthroplasty on unstable intertrochanteric fracture in the aged patients.Methods We included in this study 36 patients aged 80 years and over with intertrochanteric fracture combined with displaced femoral calcar and/or lesser trochanter,and treated them by hip hemiarthroplasty with bipolar prosthesis,retaining or reconstructing the calcar or lesser trochanter to rebuild the medial stable structure of the proximal femur.Harris score was used to assess the therapeutic effect.Results X-ray images at the 3rd day revealed no significant differences from those at the 3rd month postoperatively.Based on Harris score,12 cases achieved excellent short-term results,19 good,3 medium and 2 poor.Conclusion Hip hemiarthroplasty with bipolar prosthesis s a safe and effective surgical procedure for unstable intertrochanteric fracture of the aged patients,in which retaining or reconstructiing the calcar or lesser trochanter is critical for the stability of the prosthesis.