非骨水泥半髋关节置换术治疗老年不稳定股骨转子间骨折

Hemiarthroplasty using uncemented APL stem for treatment of unstable intertrochanteric fracture in elderly patients

目的探讨应用APL柄非骨水泥半髋关节置换术治疗老年不稳定性股骨转子间骨折的近期疗效。方法选择2008年7月至2011年12月实施APL柄人工半髋关节置换术治疗老年不稳定性股骨转子间骨折患者26例。男10例，女16例；年龄75-94岁，平均82．5岁。骨折分类按Evans—Jensen分型：Ⅱ型16例，Ⅲ型10例。结果手术时间48-72min，平均56min；术中出血240-600ml，平均360IIll。围手术期死亡患者1例，随访期间死亡患者2例。其余23例患者术后随访12-42个月，平均21．5个月。术后2~3周，患者可借助支具下床活动。术后3个月，21例患者平衡和行走能力已基本恢复至伤前水平，生活能自理。未出现髋臼磨损及股骨假体松动、下沉等手术相关并发症。脑梗死、下肢深静脉血栓各1例；泌尿系统感染2例；1例患者因长期应用激素，术后2年出现局部皮肤破溃；2例患者出现异位骨化。关节功能按Harris评价标准：优12例，良10例，可1例。结论应用APL柄非骨水泥固定半髋关节置换术治疗老年不稳定性股骨转子间骨折可以使患者摆脱因骨折愈合而卧床时间较长的困扰，早期下床活动，提高生活质量。

Objective To discuss the short-term outcomes of uncemented APL stem hip hemiarthroplasty for unstable intertrochanteric fracture in elderly patients. Methods From July 2008 to December 2011, 26 cases of intertrochanteric fractures were treated by hemiarthroplasty using uncemented APL stem. There were 10 men and 16 women with a mean age of 82.5 years （range, 75-94 years）. According to EvansJensen classification system, 16 cases were type II fractures, the other 10 were type III. Results The mean operation time was 56 min （range, 48 to 72 min）. The average blood loss during the operation was 360 ml （range, 240-600 ml）. One of the patients died in the perioperative period, 2 died during the follow-up. The other 23 patients were followed up with an average of 21.5 months （range, 12-42 months）. The patients were encouraged to walk with aid about 2-3 weeks postoperatively. Three months after the operation, the walking ability were almost recovered to pre-injury level in 21 cases. The acetabular wear, the prosthetic loosening and subsidence were not found. The complications included 1 case of cerebral infarction, 1 case of deep venous thrombosis, 2 urinary infection, 1 skin ulcer due to the long-term use of cortical steroid and 2 hetero- topic ossifications. According to Harris hip score, 12 cases were classified as excellent, 10 cases as good and 1 case as fair. Conclusion Hemiarthroplasty using uncemented APL stem is an effective way to treat the unstable intertrochanteric fracture in elderly patients. The quality of life of the elderly patients can be improved due to early mobilization after the surgery.