双动人工股骨头置换治疗骨质疏松性不稳定型股骨粗隆间骨折60例临床分析

Clinical analysis of bipolar femoral head replacement in treatment of unstable osteoporotic intertrochanteric frac-ture of femur in 60 patients

目的探讨双动人工股骨头置换治疗老年骨质疏松性不稳定型股骨粗隆间骨折的临床疗效。方法采用前瞻性研究对2006年1月至2010年12月收治的股骨粗隆间骨折患者60例。按Evans分类法,Ⅱ型16例,Ⅲ型28例,Ⅳ型16例;患者均有严重骨质疏松,采用Singh指数(即按骨小梁消失顺序和程度将股骨近端骨小梁变化分为6级),所有患者均在Ⅳ级以上。均采用骨水泥型双动人工股骨头置换术。髋骨功能采用Harris评分标准,将疗效分为优、较好、良、差。结果 60例患者中有52例获得随访,随访方式以电话随访和门诊复查为主;随访时间8～37个月,平均(26±3)个月。1例术后1个月死于全身多脏器功能衰竭;3例术后发生肺内感染,经抗感染治疗后得到控制;1例2年后出现伤口流脓感染,取出假体旷置后可扶助行器行走;4例3个月内行走时髋部疼痛,经指导锻炼后好转;余46例无明显髋部行走痛,X线片显示假体固定牢固,无松动及下沉等。本组优32例,较好12例,良5例,差3例。优良率94.2%。结论采用骨水泥双动人工股骨头置换治疗老年骨质疏松性不稳定型股骨粗隆间骨折,具有手术操作简单,卧床时间短、早期可负重活动,减少因卧床引起的术后并发症等优点。

Objective To explore the clinical therapeutic effectiveness of bipolar femoral head replacement in treatment of unstable osteoporotic intertrochanteric fracture of femur in 60 patients. Methods A prospective study were performed from January 2006 to December 2010. There were 60 patients with unstable intertroeh-anteric fractures of femur in this study. Injury reasons were primarily road accident and falling injury. According to Evan＇s classification, there were 16 patients with type Ⅱ , 28 patients with type Ⅲ, 16 patients with type IV. They were treated with biopolar femoral head replacement. These patients all had severe osteoporosis, Singh index was above grade Ⅳ. Hip function was evaluated with Harris hip score. The curative effect was divided into 4 grades,which were respectively excellent, better, good and poor. Results Fifty two patients in this group were received follow-up which were conducted by telephone and out-patient review. The time of follow-up ranged from 8 to 37 months （average time 26±3 months）. One patient died of multiple organs failure at 1 month after surgery; 3 patients who suffered from postoperative pulmonary infection were cured with antibiotics; Pus draining from infected wound was seen at 2 years after surgery in 1 patient, who was treated with removing prosthesis, then could walk with assist device; Postoperative hip pain after walking were relieved by right functional guidance in 4 patients; Other 46 patients had no obvious hip pain when walking, and X ray showed that prosthesis were fixed firmly without loosening and sinking etc. According to Harris hip score, the result showed excellent in 32 patients, better in 12 patients, good in 5 patients and poor in 3 cases, the rate of excellence and goodness was 94.2%. Conclusion Application of bipolar femoral head replacement with bone cement in treatment of osteoporotic intertrochanteric fractures in elder patients has many advantages, which include spending less time in bed, early weight- bearing activities, and reducing the occurrence of postoperative complications.