双极人工股骨头置换术治疗老年骨质疏松患者粗隆间粉碎性骨折

Treatment of bipolar femoral head replacement for intertrochanteric comminuted fractures in elderly patients with osteoporosis

目的探讨双极人工股头置换术治疗骨质疏松患者股骨粗隆间粉碎性骨折的临床疗效。方法自2006年11月至2010年11月采用双极人工股骨头置换术治疗65例伴骨质疏松的股骨粗隆间粉碎性骨折老年患者。结果 65例患者均顺利通过手术,平均手术时间为(76.3±10.3)min,术中平均失血量为(276.8±118.2)mL。住院期间无伤口感染、脱位等并发症,无死亡病例。下床时间4～15d,平均7.2d。住院时间15～28d,平均18.4d。64例获得随访,随访时间3～24个月,平均12个月,术后1个月生活基本达到自理。根据Harris评分法,优42例,良16例,可4例,差2例,优良率90.6%。1例于出院后2个月因心脏病死亡,6例术后3～7d并发患肢深静脉血栓。结论双极人工股骨头置换术治疗伴骨质疏松的粗隆间粉碎性骨折老年患者,出血量小,手术时间短,具有术后可早期下床,早期进行功能锻炼、降低并发症、提高术后生活质量等优点,临床效果满意。

Objective To study the clinical effect of bipolar femoral head replacement （FHR） for the treatment of intertrochanteric fractures in elderly patients with osteoporosis. Methods From November 2006 to November 2010, 65 elderly patients with osteoporosis complicated intertrochanteric femoral fractures were treated with bipolar femoral head replacement. Results All operations were accomplished successfully without major comlications. The mean operation time was （76.3 ±10.3） min and the mean estimate blood loss during the operation was （276.8 ± 118.2） mL. There were no infections, joint dislocation or other complications during the period of hospitalization. The mean weight-bearing walking time was 7.2 d （4-15 d） after operation. The length of stay was from 15 to 28 days （average 18 d）. A follow-up was available in 64 patients from 3 to 24 months with the average of 12 months. After one month postoperatively, 64 patients all resumed daily activities. According to Harris scoring standard, 42 patients were excellent, 16 good, 4 patients fair and 2 inferior. The excellent and good rate reached 90.6%. One patient died 2 months after the operation because of heart disease. Six patients suffered deep venous thrombosis from 3 to 7 days after the operation. Conclusion Bipolar femoral head replacement is an effective method to treat intertrochanteric fractures in elderly patients with osteoporosis, which has the advantage of less blood loss, shorter operation time, less operative injury so as to make patients early ambulate and do functional exercises early, reduce the complications and improve life quality.