人工股骨头置换治疗高龄不稳定粗隆间骨折56例分析

Treatment of unstable intertrochanteric fractures of the femur through hip arthroplasty in the elderly:A report of 56 cases

目的探讨人工股骨头置换治疗高龄患者不稳定股骨粗隆间骨折的疗效。方法 2005年1月-2010年6月收治的老年不稳定型股骨粗隆间骨折患者56例,其中男25例,女31例,年龄75～92岁,平均83岁。骨折Evan's分型Ⅲ型22例,Ⅳ型24倒,Ⅴ型10例。所有患者均施行骨水泥型人工股骨头置换,观察其治疗效果、围术期并发症及随访情况。结果所有患者均顺利完成手术,术后并发症包括深静脉血栓形成2例,一过性精神障碍2例,伪膜性肠炎2例,经对症治疗均痊愈。3例患者发生肺栓塞,2例出院后4个月跌伤致假体周围骨折。死亡2例,死亡原因分别为肺部感染及多脏器功能衰竭。术后6个月Harris评分优21例,良26例,优良率83.9%。随访12～20个月,平均16个月,未发生关节感染、脱位等。结论人工股骨头置换治疗高龄不稳定型股骨粗隆间骨折手术创伤小,并发症少,能早期下床活动,可显著提高患者的生活质量。

Objective To investigate the treatment effect of hip arthroplasty for unstable intertrochanteric fractures of the femur in the elderly.Methods Fifty-six elderly patients（25 males and 31 females,aged 75 to 92 years with mean of 83 years） with unstable intertrochanteric fractures hospitalized from January 2005 to June 2010 were involved in the present study.According to the Evan＇s fracture classification,22 cases were classified as type III,24 as type IV,and 10 as type V.All the patients received bone-cement type hip arthroplasty,and the treatment effects,perioperative complications,and follow-up results were observed.Results The operation was completed successfully for all patients.The postoperative complications included,two cases of deep venous thrombosis,two cases of transient psychotic disorder,and two cases of pseudomembranous colitis,all of which,were cured via symptomatic treatment.Three patients have had complications with pulmonary embolism and two with fractures around the prosthesis four months after discharge.Two patients died of pulmonary infection and multiple organ failure,respectively.The Harris hip score were excellent for the 21 cases and good for 26 cases.The excellent and good rating was 83.9% after six months from operation.No joint infection or dislocation occurred during the follow-up period of 12 to 20 months（mean of 16 months）.Conclusion Hip arthroplasty has been proven to be an effective treatment for unstable intertrochanteric fractures in the elderly with less surgery trauma and complications.It also allowed early ambulation and improved the quality of life of the patients.