生物型加长柄关节置换治疗高龄股骨转子间骨折

Treatment of intertrochanteric fracture by hemiarthroplasty using long-stem cementless implant in aged patients

目的探讨应用Zweymtiller生物型加长柄关节置换治疗高龄股骨转子间骨折的手术可行性、实用性和疗效。方法回顾性分析2006年6月至2010年6月应用Zweymiiller生物型加长柄关节置换治疗91例高龄股骨转子间骨折患者资料，男35例，女56例；年龄75-94岁，平均81．2岁。股骨转子间骨折按Evans—Jensen分型：Ⅲ型36例，Ⅳ型55例。骨质疏松按Singh指数分级：Ⅲ级51例，Ⅱ级40例。损伤至手术时间2～10d，平均3．5d。全部采用Zweymtiller生物型加长柄股骨假体。根据Harris评分评价髋关节功能。结果手术时间30-50min，平均39min；出血量320-4510ml，平均405ml。术后91例患者切口均一期愈合，住院时间14-21d，平均16．5d。2例于术后第3天发生呼吸系统感染，经抗感染、化痰、平喘、机械通气等治疗痊愈；3例发生深静脉栓塞，经介入科在下腔静脉植入滤网溶栓治疗后痊愈；2例发生肺梗死，其中1例在发病2h内死亡，另1例急诊CT血管造影检查确诊后转入ICU行溶栓治疗后康复。55例患者获得随访，其中18例在此期间因其他疾病死亡，实际37例获得随访，随访时间15-38个月，平均24．5个月。末次随访时Harris评分为40-96分，其中优13例，良18例，可4例，差2例，优良率83．8％（31／37）。无一例发生骨溶解、异位骨化、假体松动下沉；1例患者术后6个月摔倒致假体周围斜型骨折，行切开复位捆绑带固定15d后出院。结论Zweymtfller生物型加长柄关节置换是治疗高龄股骨转子间骨折的一种有效方法，术后患者可早期下地负重活动，功能恢复良好。

Objective To discuss the clinical effects of hemiarthroplasty for the treatment of intertrochanteric comminuted fracture in aged patients. Methods From June 2006 to June 2010, 91 cases with intertrochanteric comminuted fractures were treated by hemiarthroplasty using Zweymtiller long-stem cementless implant. There were 35 males and 56 females, with an average age of 81.2 years （range, 75-94 years）. There were fresh fractures in 75 cases and old fractures in 16 cases. According to classification of E- vans-Jensen, there were 36 cases with type III fracture and 55 with type IV. Osteoporosis was graded by Singh index, and there were 51 cases with level III and 40 with level II. The interval between injury and operation was 2-10 d （average, 3.5 d）. Results The surgery lasted 30-50 min （average, 39 rain）. The blood loss was 320-610 ml （average, 405 ml）. The hospital stay was 14-21 d （average, 16.5 d）. Two cases who experienced with the infection of the respiratory system after operation, recovered through routine treatment. Thirty-seven cases were followed up for 15 to 38 months （average, 24.5 months）. According to the Harris score, the overall rate of excellent or good result was 83.8% （31/37）. Conclusion Hemiarthroplasty using Zweymtiller long-stem cementless prosthesis is reliable option for intertrochanteric comminuted fracture in the aged patients.