骨水泥型长柄人工股骨头置换术治疗高龄股骨粗隆间骨折的临床体会

Hemiarthroplasty with long-handled bone cement for elderly patients with intertroehan- terlc fractures

目的探讨骨水泥型长柄人工股骨头置换治疗有骨质疏松的高龄不稳定型股骨粗隆间骨折患者的疗效。方法2005年6月-2010年12月，采用骨水泥型长柄人工股骨头置换治疗有骨质疏松的高龄不稳定型股骨粗隆间骨折36例，其中男14例，女22例；年龄70～93岁，平均76岁。骨折按Evans分型，Ⅰ型3度10例，Ⅰ型4度22例，Ⅱ型4例。结果36例患者均获随访，时间6—32个月，平均18个月。所有患者伤口Ⅰ／甲愈合，无死亡病例，绝大部分恢复术前行走功能水平，髋关节功能按Harris评分标准总优良率为77．7％。结论应用该技术治疗高龄不稳定型股骨粗隆间骨折具有手术时间短（平均48分钟）、下地时间早（平均10天）、最大化预防各种并发症的优点。

Objective To explore the efficacy of hemiarthroplasty with long-handled bone ce- ment in the treatment of elderly osteoporosis patients with unstable intertrochanteric fractures. Methods Hemiarthroplasty with long-handled bone cement was performed on 36 osteoporosis patients ages 70 to 93 with unstable intertrochanteric fractures during the period of June 2005 to December 2010, including 14 males and 22 females. According to the Evans classification, 10 patients were type Ⅰ with degree 3, 22 were type Ⅰ with degree 4, and 4 were type Ⅱ. Results 36 patients were followed up for 6 to 32 months,with an average of 18 months. The wounds healed by first intention in all the patients; and no deaths occurred. Most of the patients regain the ambulatory function at the preoperative level. According to Harris hip function score, 77-7% of the patients reached excellent standards. Conclusions This technique for elderly patients with unstable intertrochanteric fractures shortens the surgical duration （mean 48 minutes）, achieves earlier ambulation time （an average of 10 days）, and maximizes the prevention of complications.