采用Wagner SL股骨柄假体半髋置换治疗高龄股骨转子间骨折的疗效观察

Clinical observations of femoral intertrochanteric fracture in elderly patients with Wagner SL prosthetic replacement

目的：探讨WagnerSL股骨柄治疗高龄股骨转子间骨折的方法。方法：2008年8月～2009年8月，采用Wag．nerSL股骨柄假体进行半髋置换术治疗股骨转子间骨折患者21例，男9例，女12例；按Jensen—Evans分型均为不稳定骨折。采用Singh分级评定骨质量均为骨质疏松。选择WagnerSL股骨柄假体进行半髋置换术。结果：平均部分负重时间为术后第3～5天，随访时间10—15个月，平均12个月，无失访病例。21例患者伤口均为一期愈合，术后及随访X线片假体位置好，均无明显疼痛，无髋关节脱位和假体松动，无下肢深静脉血栓等，双下肢不等长6例，均在1cm以内。术后最后1次随访Harris评分优14例，良5例，可2例，优良率达90．5％。结论：WagnerSL股骨柄治疗股骨转子间骨折具有允许术后早期完全负重活动、降低并发症和功能恢复满意等优点，是治疗老年股骨转子间骨折合并骨质疏松较理想的手术方法。

Objective： To explore the clinical outcome of femoral intertrochanteric fracture in elderly patients treated by Wagner SL prosthetic replacement. Methods： 21 elderly patients of femoral intertrochanteric fracture were treated with Wagner SL prosthetic replacement from August 2008 to August 2009. There were 9 males and 12females. They were all unstable fractures measured by Jensen-Evans classification. The quality of the bone was all osteoporoses rated by the Singh index. The fractures were treated with Wagner SL prosthetic replacement. Results： The mean partial weight-bearing time was the third to fifth days postoperatively. The mean duration of follow up was 12 months （10-15 months）, no lost. The wound healing was smooth in all patients. The prostheses were good measured by X-ray. There was no pain, no dislocation or loosening, no DVT. There were bilateral discrepancies of the lower extremities in 6 cases, less than 1 cm. There were ex- cellent in 14 cases, good in 5 cases and fair in 2 cases based on the Harris score postoperatively. The overall excellent and good rate was 90.5%. Conclusion： Wagner SL prosthetic replacement can provide early full weight-bearing, reduce the in- cidence of post-operative complications and get satisfactory rehabilitation. It is one kind of ideal treatment for elderly pa- tients with femoral intertrochanteric fracture and osteoporosis.