长柄人工股骨头置换治疗32例老年股骨粗隆间不稳定型骨折

Long-stem artificial femoral head replacement for treating unstable lntertrochanteric fracture in 32 elderly cases

目的探讨长柄人工股骨头置换并重建大小粗隆治疗老年股骨粗隆间不稳定型骨折的临床疗效。方法应用长柄人工股骨头置换并重建大小粗隆治疗70岁以上高龄股骨粗隆间不稳定型骨折32例,骨折类型按Evans分型:Ⅲ型21例,Ⅳ型11例。观察骨折愈合时间、关节功能及术后并发症情况。结果 32例患者均获得随访,平均随访时间13个月。26例患者术后3个月骨折处有满意骨痂生长;32例患者术后6个月骨折均已骨性愈合。根据Harris评定标准评价术后1年髋关节功能:优25例(78.1%),良5例(15.6%),可2例(6.3%),差0例,优良率达93.7%。无关节感染、脱位、假体周围骨折等并发症发生。结论长柄人工股骨头置换治疗高龄股骨粗隆间不稳定型骨折具有下地早、恢复快、并发症少、关节功能好等优点,是一种适合老年患者的手术方法。

Objective To evaluate the clinical result of long-stem artificial femoral head replacement and lesser and greater trochanter reconstruction for the treatment of unstable intertrochanteric fracture in elderly patients.Methods 32 patients（aged more than 70 years） with unstable intertrochanteric fracture were treated with long-stem artificial femoral head replacement and lesser and greater trochanter reconstruction.There were type Ⅲ fracture in 21 cases and type Ⅳ fracture in 11 cases according to the Evans classification.The fracture union time,hip functional recovery and operational complications were observed.Results All 32 patients were followed up（13 months on average）.26 patients had obvious callus formation at postoperative 3 months,32 patients obtained bone union at postoperative 6 months.The results were excellent in 25 cases（78.1%）,good in 5（15.6%）,fair in 2（6.3%） and poor in 0 according to Harries standard one year after the operation.The excellent rate was 93.7%.No infection,dislocation or fracture around prosthesis occurred.Conclusion Long-stem artificial femoral head replacement for the treatment of unstable intertrochanteric fracture in elderly patients proves to be a suitable alternative.Patients have early weight bearing,rapid rehabilitation,few complications and good hip functional recovery.