人工双极股骨头置换术治疗老老年股骨颈骨折的疗效分析

Effect of Bipolar Hemiarthroplasty in Treating Femoral Neck Fracture in Super-aged Patients

目的探讨人工双极股骨头置换术治疗老老年(>80岁)股骨颈骨折的临床疗效。方法 2006年1月-2009年12月采用人工双极股骨头置换术治疗23例老老年股骨颈骨折患者,其中男8例,女15例;年龄81～100岁,平均88岁。左侧10例,右侧13例。致伤原因:走路摔伤20例,交通事故伤3例。骨折按Garden分型:Ⅲ型14例,Ⅳ型9例。均为新鲜骨折,受伤至手术时间3～12d。术前均合并慢性内科疾病。结果术后切口均I期愈合,3例发生肺部感染,1例发生深静脉血栓形成,无切口感染及假体脱位。2例患者分别于术后5个月死于急性心肌梗死及术后1年死于高血压性脑溢血。余21例均获随访,随访时间12～48个月,平均26个月。X线片示假体位置良好。根据Harris髋关节评分标准:优12例,良6例,可2例,差1例,优良率为85.7%。结论人工双极股骨头置换术治疗老老年股骨颈骨折手术时间短,可早期髋关节活动,减少了卧床并发症,提高了生存率,改善了患者生活质量,是一种较理想的治疗手段。

Objective To discuss the clinical effects of bipolar hemiarthroplasty for treatment of femoral neck fracture in super-aged patients who were over 80 years old.Methods From January 2006 to December 2009,23 cases of femoral neck fracture were operated by bipolar hemiarthroplasty.Among the patients,there were 8 males and 15 females,with their age ranged from 81 to 100 years old averaging at 87.5 years.Ten patients had left femoral neck fracture,and 13 had right femoral neck fracture.Twenty patients had the injury because of falling on the ground while walking,and 3 due to car accident.Based on Garden classification,there were 14 cases of type Ⅲ and 9 of type Ⅳ fractures.All fractures were fresh.The interval between the injury and operation was 3 to 12 days.Before operation,all patients had concomitant chronic diseases.Results All incisions healed in the first stage with 3 cases of lung infection and 1 case of deep venous thrombus,and without incision infection or prosthesis dislocation.One patient died of acute myocardial infarction 5 months after operation and the other one died of hypertensive cerebral hemorrhage 1 year after operation.All the remaining 21 patients were followed up for 12 to 48 months averaging at 26 months.X-ray result showed a good location of the prosthesis.According to the Harris scoring system,the results were very good in 12 cases,good in 6 cases,fair in 2 cases and poor in 1 cases,with a total effective rate of 85.7%.Conclusions Bipolar hemiarthroplasty is an ideal method to treat femoral neck fracture in super-aged patients.It can shorten operation time,facilitate early movements of the hip joint,decrease complication rate due to lying in bed,and improve survival rate and quality of life