双动头置换术治疗高龄粗隆间骨折疗效分析

Cemented Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Aged Patients

目的探讨骨水泥型双动头置换术治疗高龄不稳定性股骨粗隆间骨折的临床疗效及适应症的选择。方法新疆维吾尔自治区人民医院于2009年1月-2010年6月共收治29例75岁以上高龄不稳定性股骨粗隆间骨折患者,男性18例,女性11例;年龄75～93岁,平均80岁。按Jensen分型,Ⅲ型12例,Ⅳ型14例,Ⅴ型3例,术前双能量Χ线骨密度检查均在-2.5以下,均行双动头置换术,并在术后1年随访,进行Harris评分。结果术中1例出现骨水泥反应,术后切口均一期愈合,随访1年,1例术后4月死于冠心病,2例死于脑梗死,1例术后2个月时死于肺部感染。Harris评分优良4例,较好14例,尚可7例,术后患者早期下床,术后并发症较少。结论用骨水泥型双动头置换术治疗高龄不稳定性粗隆间骨折,手术操作简单,降低并发症的发生,是一种可供选择的有效方法。

Objective To investigate the therapeutic effect of cemented bipolar hemiarthroplasty in the treatment of unstable intertrochanteric fractures in aged patients and its operation indicates. Methods Twenty nine cases aged over 75 years old received cemented bipolar hemiarthroplasty from January 2009 to June 2010,18 male, 11 female aged from 75 - 93 years old, average 80 years. According to Jensen type,there were type HI 12 cases,type IV 14 cases,type V 3 cases. The preoperative bone densitometry with Dual-energy X-ray absorptiometry indicated that all patients were with osteoporosis （ BMD ： below - 2.5 ）. After the operation, all patients were follow-up 1 year and received Harris score. Results One case has bone cement reaction during operation. Incision was primary healing post-operation. The follow-up showed that one case was dead from coronary heart disease 4 months afteroperation,2 cases dead from cerebral infarction;one case was dead from pulmonary infection 2 months after opera- tion. According to the Harris score, best ： 8 cases, better： 14 cases, acceptable ： 7 cases, patients can to get out of bed at early-time post-operation,also less complication. Conclusion The operative procedure of cemented bipolar hemiarthroplasty is easy and has less oost-operation comolication, and can be selected for unstable intertroehanteric fractures in aged patients.