高龄股骨转子间骨折人工关节置换的特点及假体选择

Treatment features and prosthesis selection of artificial joint replacement for elderly intertrochanteric fracture

目的:探讨高龄不稳定型转子间骨折人工关节置换不同假体的选择策略及临床治疗特点。方法:采用电子检索的方式,在万方数据库(http://www.wanfangdata.com.cn/)中检索2000-01/2010-08有关高龄股骨转子间骨折人工关节置换的研究文章,关键词为"股骨转子间,骨折,人工关节,高龄"。排除重复研究、普通综述或Meta分析类文章,筛选纳入25篇文献进行评价。结果:高龄股骨转子间骨折人工髋关节置换前正确的假体选择很重要,应根据Evans标准分类以及股骨近端骨折情况进行选择。根据人工髋关节假体的类型,目前分为3类:第一类是根据不同的柄长来选择,即加长柄人工关节与普通柄长人工关节的选择;第二类是全髋关节假体与双极人工股骨头假体的选择;第三类是骨水泥型柄与生物型柄假体的选择。另外应该按照骨质情况选择,骨水泥型假体可获得置换后即刻稳定,因此绝大多数高龄不稳定型骨骨转子间骨折更适合于选择骨水泥型假体。结论:根据骨折类型以及患者全身情况选择不同类型的人工关节假体来治疗高龄股骨转子间骨折安全有效,功能恢复快,并发症少。

OBJECTIVE：To explore prosthesis selection and clinical treatment features of artificial joint replacement for elderly unstable intertrochanteric fracture.METHODS：A computer-based online search of Wanfang database（http：//www.wanfangdata.com.cn/）was performed for articles related to artificial joint replacement for elderly unstable intertrochanteric fracture published between January 2000 and August 2010,with Key words＂intertrochanteric,fracture,artificial joint,elderly＂ in Chinese.Repetitive study,review articles and Meta analysis was excluded.A total of 25 articles were included.RESULTS：Prosthesis selection is very important for artificial joint replacement for elderly unstable intertrochanteric fracture.The prosthesis should be selected according to Evans standard classification and proximal femoral fracture condition.The artificial hip prosthesis is classified into three types：shaft length,i.e.lengthened shaft or common shaft;total hip prosthesis and bipolar femoral head prosthesis;cemented shaft and biological shaft prosthesis.In addition,the prosthesis should be selected according to sclerotin condition.Cemented prosthesis can obtain immediately stability following replacement,so it is recommended for most elderly patients with unstable intertrochanteric fracture.CONCLUSION：Artificial joint prosthesis selected according to fracture type and patient condition is safe and effective in treating elderly intertrochanteric fracture,which can rapidly restore function and reduce complications.