60岁以上患者人工股骨头置换分析

Analysis of Artificial Femoral Head Replacement for Patient Above 60 years Old

目的：探讨６０岁以上患者人工股骨头置换手术治疗时术前准备，手术入路及疗效．方法：回顾性分析８７例６０岁以上患者人工股骨头置换术手术治疗的临床资料．结果：①７２例经髋关节前外侧入路手术，其中６１例术前采用下肢皮牵引带牵引，１１例术前采用骨牵引，术中复位均较容易；术后优良者占９３．１％，很好者占４．２％，好者占２．７％，十年内无后脱位和修正者．②１５例经髋关节后侧入路手术．其中１２例术前采用骨牵引，术中复位较容易；术后优良者占８０％，好者占１３．３％，尚可占６．７％；术后后脱位者２例，十年内修正者２例；另３例术前采用下肢皮牵引，术中难复位２例，稍难复位１例；五年内无后脱位者，２例进行修正术．结论：６０岁以上．患者人工股骨头置换手术采用髋关节前外侧入路较理想，术前采用下肢皮牵引带牵引即可，不需骨牵引；股骨距（即股骨颈内侧皮质）残留长度和术后早期功能锻炼是决定疗效的关键．

Objective:To discuss preoperative preparation, operating approach and curative effect in artificial femoral head replacement for patients above 60 years old. Methods: 87 cases underwent artificial femoral head replacement were retrospectively studied. Results: 1. The intraoperative reposition of 61 cases of skin traction bandage in lower extremity and 11 of skeletal traction were easier in 72 cases of anterolateral approach to the hip joint. The postoperative excellent rate was 93.1 %, better rate 4.2% and good rate 2.7%. There were no one case taken backward dislocation and corrected in 5 years. 2. 15 cases of artificial femoral head replacement were taken via posterior approach to the hip joint and introperative reposition of 12 cases skeletal traction were easier. The postoperative curative excellent rate was 80.0%; good rate 13.3% and ordinary rate 6.7%. There were 2 cases had been taken backward dislocation and 2 corrected in 5 years. The introperative reposition of 2 cases was difficult in 3 of skin traction bandage of lower extremity. 2 cases had been corrected in 5 years. Conclusions: The anterolateral approach to the hip joint could be most satisfactory in artificial femoral head replacement for patient above 60 years old. Preoperative skin traction should be needed. Remained length of femur range and early divagation should be key factors for the effect.