人工髋关节置换术治疗老年陈旧性股骨颈骨折

Hip arthroplasty in the treatment of old femoral neck fractures in the elderly

目的评估人工髋关节置换术治疗老年陈旧性股骨颈骨折的短期临床疗效。方法 2006年1月至2011年12月,采用人工髋关节置换术治疗老年陈旧性股骨颈骨折25例26髋,男12例,女13例,其中1例女性为双侧,平均年龄72岁(55～84岁),骨折至手术时间平均5.6个月(3～25个月)。术前分析延迟治疗的原因,术前拍摄X线片,仔细进行模板测量,确定髋关节旋转中心、偏距、髋臼和股骨假体大小、颈长和截骨位置;术后3、6个月、1年及以后每年均复查并拍X线片了解假体的状况,采用Harris评分评估术后患髋功能恢复情况。结果术后随访36个月(12～60个月),术后1年内死亡2例,发生深静脉栓塞1例,出现坐骨神经麻痹1例。无术后关节感染及脱位,无术后人工假体下沉、断裂、松动等并发症发生。术后1年随访Harris评分83.68分(59～90分),与术前相比(Harris评分28.70分)差异有统计学意义(P<0.05);18例患髋无疼痛,5例偶尔存在疼痛,2例存在中度不适,疗效满意。结论人工髋关节置换术能有效改善老年陈旧性股骨颈骨折患者髋关节功能,减轻疼痛,提高患者的生活质量。

Objective To evaluate the short-term clinical outcomes of hip arthroplasty in the treatment of old femoral neck fractures in elderly patients. Methods From January 2006 to December 2011, 25 elderly patients （26 hip joints） with old femoral neck fractures were treated with hip arthroplasty. There were 12 males and 13 females, among whom 1 female patient had bilateral fractures. The mean age of the patients was 72 years old （range; 55-84 years）. The mean time interval from injury to operation was 5.6 months （range; 3-25 months）. Preoperatively the reason of the delayed treatment was analyzed, and the X-ray films were shot. The templates were measured carefully, and the hip rotation center, offset distance, the acetabulum and the size of the femoral prosthesis, the neck length and cut bone position were determined. The X-ray films were reviewed and shot to assess the status of the prosthesis 3, 6 and 12 months postoperatively, and then yearly. The hip function rehabilitation after the operation was evaluated using the Harris hip scores. Results The patients were followed up for a mean period of 36 months （range; 12-60 months） after the operation. 2 patients were dead within 1 year postoperatively, with 1 case of deep vein thrombosis and 1 case of sciatic nerve palsy. No postoperative infection or dislocation of the joints occurred. No such complications as postoperative artificial prosthesis sinking, breakage, loosening and so on were found. The mean Harris score in the follow-up of 1 year was 83.68 points （range; 59-90 points）, which was 28.70 points preoperatively, and the differences between them were statistically significant （P〈0.05）. Hip pain was absent in 18 patients, 5 patients had slight pain occasionally, and 2 patients had moderate discomfort. The clinical outcomes were satisfactory. Conclusions Hip arthroplasty in the treatment of old femoral neck fractures in the elderly can improve the hip function of the patients, relieve pain and improve the patients’ quality of life.