人工半髋置换治疗老年股骨粗隆间不稳定型骨折

Treatment of Femoral Intertrochanteric Fractures With Hemi-hip Prosthesis Replacement in Elderly Patients

目的评估人工半髋治疗老年股骨粗隆间骨折的临床疗效。方法 2007-01/2010-03采用骨水泥型双动人工半髋治疗老年股骨粗隆间不稳定性骨折16例。年龄70-89岁,平均81岁,均为新鲜骨折;取后外侧切口,保留大小粗隆部位骨块,将其复位,钢丝固定,切断股骨颈,取出股骨头,插入股骨柄,安放人工头,观察住院时间、术后行走负重时间、并发症及死亡率。随访1-3年,平均1.2年。结果平均住院23 d,术后1周均能扶助行器行走,术后15-29 d（平均21 d）能完全负重行走,术后3-6个月肢体功能恢复到伤前水平,无1例死于术后并发症。随访期内假体无脱位,髋臼无明显磨损。Harris髋关节功能评分：获得优5例,良8例,可2例,差1例。优良率81.2%结论对于70岁以上有严重骨质疏松的股骨粗隆间不稳定型骨折,采用人工半髋置换治疗,效果良好,可早期下床活动,减少并发症,降低死亡率,提高生活质量。

Objective To evaluate the clinical effect of treatment of the femoral intertrochanteric fractures with hemi-hip prosthesis replacement in elderly patients.Methods From January,2007 to March,2010,16 cases with unstable femoral intertrochanteric fractures of over 70 years old underwent cement hemi-hip prosthesis replacement.The mean age was 81（ranging from 70 to 89）.All cases were fresh fracture.Took posterolateral incision,fractured fragments of large trochanter and minor trochanter preserved during the operation and fixed with steel wires and insertion of artificial femoral head.Hospital stay,postoperative weight-bearing walking time,complications and mortality were observed.The mean follow-up was 1.2 years（ranging from 1 to 3 years）.Results The average time of hospital stay was 23 days.The average time to ambulate was 21days.After 15-29 days（average 21days） to full weight bearing walking,3 to 6 months after operation,limb function returned to pre-injury level.No patients died for operative complication post-operative.There were no acetabular wear and prosthesis dislocation during the follow-up.According to Harris evaluation,5 excellent,8 good,2 fair,and 1 Poor,excellent and good accounted for 82.1%.Conclusion For elderly patients with unstable femoral intertrochanteric fracture especially with extensive osteoporosis,hemi-hip prosthetie replacement therapy has good effect,and early ambulation,with complications and mortality reduced,which could improve quality of life.