骨水泥型人工股骨头置换在高龄股骨颈骨折患者中的临床应用

Clinical application of bone cement type of artificial femoral head replacement in treatment of senile patients with femoral neck fracture

目的探讨骨水泥型双极人工股骨头置换治疗高龄股骨颈骨折的方法及临床疗效。方法回顾性分析2008年3月至2012年8月经骨水泥型双极人工股骨头置换术治疗的95例高龄股骨颈骨折患者的临床资料。结果患者均手术顺利，手术时间为（46．5±3．5）min，术中出血量为（195．0±4．5）ml。术后x线片示股骨假体位置良好，无髋内、外翻，无压疮、坠积性肺炎、泌尿系统感染或深静脉血栓形成等并发症发生。Harris髋关节功能评分优73例、良15例、可6例、差1例，优良率为92．6％。随访11—26个月，67例逐渐弃拐行走，28例需扶拐行走。复查x线片见髋臼磨损3例，髋臼负重区轻度硬化3例，骨水泥与假体周围出现透亮区2例，股骨距吸收2例，无假体脱位、松动、下沉、感染等发生。结论骨水泥型双极人工股骨头置换术治疗高龄股骨颈骨折创伤小、出血少，可早期下床康复锻炼，明显减少并发症，临床应用安全，疗效满意。

Objective To investigate the methods and clinical effects of bone cement type of artificial femoral head replacement in treatment of senile patients with femoral neck fracture. Meth- ods The clinical data of 95 senile patients with femoral neck fracture treated by bone cement type of ar- tificial femoral head replacement, from March 2008 to August 2012, were retrospectively analyzed. Re- suits All patients had successful operations, the operation time was （46. 5 ±3.5 ） min, and the bleeding volume during operation was （ 195.0 ± 4.5 ） ml. Postoperative X-ray showed the femur prosthesis location was fine. There were no complications such as hip varus or valgus, pressure sores, hypostatic pneumoni- a, urinary system infection, deep venous thrombosis. Harris hip joint function score： 73 cases were ex- cellent, 15 cases were good, 6 cases were OK, and 1 case was poor, the good and excellent rate was 92.6%. The follow-up was 11 to 26 months, 67 cases could walk without crutches, 28 cases needed to walk with crutches. The reviewed X-ray showed 3 cases of acetabulum abrasion, 3 cases of mild harden- ing in acetabulum weight-bearing area, 2 cases of bright zone around the bone cement and prosthesis, 2 cases of calcar femorale absorption, but there was no prosthesis drop, loosening, subsidence or infection. Conclusions The bone cement type of artificial femoral head replacement in treatment of senile femoral neck fracture has the advantages of small trauma, less hemorrhage, and can take rehabilitation exercise earlier. Besides, the incidence of complication is reduced obviously, and the clinical application is safe, the curative effect is satisfied.