加长柄人工股骨头置换术治疗高龄股骨粗隆部不稳定骨折15例效果评价

Effect of Artificial Long-stem Femoral Head Replacement for the Treatment of Unstable Intertrochanteric Fractures of 15 Elderly Patients

目的：分析和评价加长柄人工股骨头置换术治疗高龄股骨粗隆部不稳定骨折的方法及疗效。方法：本组15例，男10例，女5例；年龄70～90}0，平均79岁。骨折按Evans分类，ⅢA型9例，ⅢB型6例。取髋关节后外侧切口，术中注意保留股骨大、小转子部位的骨折块，用骨水泥固定，争取将其重新复位。由于股骨颈及股骨距骨缺损，在插入人工股骨柄之前可用试模测试。股骨距部位的骨缺损用骨水泥充填重塑，关节腔内置负压引流管48—72h。结果：15例患者均康复出院。住院时间16～24d，平均20d。均获得随访，平均随访时间8个月（6—12个月），伤口均一期愈合，无感染，无假体松动，无下肢深静脉栓塞发生，无髋关节脱位或半脱位发生，无病人死于手术并发症，12例病人髋关节功能满意。结论：加长柄人工股骨头置换术是治疗高龄股骨粗隆部不稳定骨折的可靠方法，其操作可行，疗效满意，可降低死亡率、改善生活质量。

Objective： To explore and evaluate the method of artificial long-stem femoral head replacement for the treatment of unstable intertroehanteric fractures of 15 elderly patients. Methods： Fifteen cases of elderly aged 70-90 years old （average 79 years old, 10 male and 5 female） were enrolled in study. Fractures were typed according to Evans classification： 9 cases of type 111 A, 6 cases of type m B. Applied the posterolateral hip incision, fractured fragments of large trochanter and minor trochanter should be preserved during the operations that the fragments could be fixed with bone cement. A model could be used before insertion of artificial femoral shaft because of the defects of femoral neck and femoral calcar. Bone defects in the femoral ealcar were stuffed with bone cement, suction drainage were maintained for 48-72 hours. Results： All fifteen patients were cured and discharged. The period of hospitalization was 16-24 days （average 20 days）. Follow up for 6-12 months （average eight months） was performed in 15 cases, all wounds were primary healed without infection,dislocation, lower extremity deep vein thrombosis, hip dislocation or subluxation and death. The function of hip joint was satisfied in 12 patients. Conclusion： artificial long-stem femoral head replacement for the treatment of unstable intertrochanteric fractures in the elderly is a reliable, feasible and effective method which can decrease mortality and improve life quality.