高龄股骨转子间骨折人工股骨头置换及围术期特点

Femoral intertrochanteric fractures in the elderly with artificial femoral head replacement and perioperative characteristics

目的探讨高龄骨质疏松性股骨转子间骨折行人工股骨头置换及围术期特点。方法通过对31例高龄骨质疏松性股骨转子间新鲜骨折,年龄75～93岁,平均82.5岁。对骨质疏松行singh指数分级II级23例,III级8例,均行人工股骨头置换术。对围术期特点、治疗、康复锻炼及微创手术进行回顾性分析。结果 31例患者均获随访,随访时间12～47个月,平均17.5个月。平均手术时间86 min,平均术中出血450 ml。11例(35.5%)患者术后出现新的并发症,其中心血管系统的并发症(低血压、心功能不全、房颤)最多,为16%(5例)。肺部感染者6.5%(2例)。低Cl—、低K+、低蛋白血症者13%(4例)。Harris髋关节功能评分,优15例、良10例、可5例、差1例。优良率80.6%。结论高龄转子间骨折患者合併多种内科疾病,存在骨质疏松,行人工股骨头置术,手术风险高,成功的关键在于充分围术期准备、微创操作,缩短手术时间。早期主被动功能锻炼及抗骨质疏松处理。

Objective Senile osteoporotic femoral intertrochanteric fractures with artificial femoral head replacement and perioperative characteristics. Methods 31 cases of senile osteoporotic intertrochanteric fresh fracture, age 75-93 years old, average 82.5 years old. On the osteoporosis Singh index grade II 23 cases, III 8 cases, underwent artificial femoral head replacement. On perioperative characteristics, treatment, rehabilitation training and minimally invasive operation were retrospectively analyzed..Results 31 cases were followed up, follow-up time 1247 months, an average of 17.5 months. The average operation time of 86min, mean intraoperative bleeding of 450ml. In 11 cases （ 35.5% ） patients after the appearance of new complications, including cardiovascular system complication （hypotension, heart failure, atrial fibrillation） up to 16% （5 cases）. Pulmonary infection in 6.5% （2 cases）. Low CI, low K~, hypoalbuminemia in 13% （4 cases）. The Harris hip score, 15 cases were excellent, good in 9 cases, in 5 cases, poor in 1 cases. The excellent and good rate was 77.5%. Conclusion the intertrochanteric fracture in the elderly with multiple internal medicine disease osteoporosis, artificial femoral head in the operation, high risk, the key to success is full of perioperative preparation, minimally invasive operation, shorten the operation time. Early passive functional exercise and osteoporosis treatment.