骨水泥型人工髋关节置换术治疗老年不稳定股骨粗隆间骨折

Cemented hip arthroplasty for unstable femoral intertrochanteric fractures in elderly patients

目的探讨骨水泥型人工髋关节置换术治疗老年不稳定股骨粗隆间骨折的手术技术和疗效。方法采用骨水泥型柄行人工髋关节置换术治疗29例老年不稳定股骨粗隆间骨折，其中行全髋关节置换术6例，标准双极人工股骨头置换术23例。结果本组手术时间51～90min，平均78min；术中出血量300—600ml，平均410ml；其中19例术中输血，输血量200～800ml，平均320ml。随访期间死亡1例，其余28例术后随访5～30个月，平均18．6个月。术后1d患者可拄双拐下床活动。术后1个半月，24例患肢功能明显改善，行走能力基本恢复到伤前水平。未出现髋臼磨损及股骨假体松动、下沉等并发症。出现脑梗死1例，下肢深静脉血栓2例，异位骨化2例。髋关节功能按Harris评分标准评定：优6例，良18例，可4例，差1例。结论骨水泥型人工髋关节置换术治疗老年不稳定股骨粗隆间骨折有良好的近期疗效。

Objective To discuss the surgical technique and efficacy of the cemented hip arthroplasty for unstable femoral intertrochanterie fractures in elderly patients. Methods Twenty-nine elderly patients with unstable femoral interthochanterie fractures were treated with cemented hip arthroplasty. Of wiheh, 6 patients were treated with total hip replacement, 23 patients were treated with standard bipolar artificial femoral head replacement. Results The average operation time was 78 min （ranging from 51 to 90 min）. The mean blood loss during the operation was 410 ml （ranging from 300 to 600 ml）. One of the patients died during the follow-up. The other 28 patients were followed up with an average of 18.6 months（ranging from 5 to 30 months）. The patients were able to walk with erutehes about 1 day postoperatively. One and half months after the operation ,the ability to walk was almost the same as that before injury in 24 cases. The acetabular abrasion, the femoral prosthetic loosening and subsidence were not found. The complications included 1 case of cerebral infaretion, 2 eases of deep venous thrombosis and 2 cases of heterotopie ossifications. According to Harris hip score, 6 cases were classified as excellent, 18 cases as good, 4 eases as fair and 1 case as poor. Coneluslon The short-term results of cemented hiP arthroplasty in elderly patients with unstable femoral intertrochanteric fractures are satisfactory.