老年髋关节置换术后继发对侧髋部骨折的治疗

Treatment of recurrence of the contralateral hip fracture after hip replacement for senil patients

目的探讨老年髋关节置换术后继发对侧髋部骨折的治疗策略。方法回顾性比较21例老年髋关节置换术后继发对侧髋部骨折病例两次骨折时的ASA分级、术后入住重症监护室(ICU)例数、手术时间、手术前住院时间、总住院时间、再骨折髋Singh指数、手术方式、假体类型、髋关节功能评分。结果全组两次骨折时ASA分级≤2级患者分别为12例、5例,>2级患者为9例、16例(P<0.05);术后入住ICU例数分别为2例、8例,手术时间分别为(69.43±11.29)min、(54.38±12.86)min,手术前住院时间分别为(3.33±1.62)d、(5.05±1.94)d,总住院时间分别为(20.90±4.39)d、(26.81±10.11)d(P<0.05);再骨折髋Singh指数>Ⅲ级例数为9例、1例,≤Ⅲ级的例数为12例、20例(P<0.05)。再骨折类型中股骨颈骨折14例(66.7%),转子间骨折7例(33.3%)。股骨颈骨折患者均采用假体置换术治疗,其中12例选用骨水泥型人工股骨双动头假体。转子间骨折中5例应用内固定(DHS 1例,PFNA 4例),2例应用骨水泥型定制人工股骨双动头假体治疗。21例均获随访,再骨折术后随访(16.82±5.17)个月。先后手术的两侧髋关节Harris功能评分为(94.41±3.59)分、(90.73±7.62)分(P>0.05)。未发生骨不愈合、内固定物或假体松动、感染等并发症。结论老年髋关节假体置换术后继发对侧髋部骨折的治疗更复杂,应在基础病防治、抗骨质疏松治疗基础上选择不同手术方法。继发股骨颈骨折首选水泥型单纯股骨头置换术;转子间骨折以内固定首选,也可行假体置换术。

[Objective] To investigate the treatment for the contralateral hip fracture after hip replacement for the aged patients. [Methods] The clinical data of 21 cases with the contralateral hip fracture after hip replacement for the aged was analyzed retrospectively. Compare the ASA physical status, number of postoperative stay in intensive care unit （ICU）, surgery time, length of hospital stay before the operation, the total length of hospital stay, hip Singh index, operation method, type of prosthesis and hip function score for the continuous two fractures. [Results] For the continuous two fractures, the ASA physical status, ≤ class 2 in the cases of 12, 5 and 〉 grade 2 as 9, 16 cases; The postoperative ICU admission cases for 2 and 8 respectively; Operation time was （69.43±11.29）, （54.38 ± 12.86） rain; hospital stay before the operation was （3.33 ± 1.62）, （5.05 ± 1.94） d; The total length of hospital stay was （20.90±4.39）, （26.81±10.11）d; for Singh index of the refracture hip, the case greater than Ⅲ level was 9, Ⅲ level or less for 12 when Initial fracture, but 1 and 20 were consisted in refracture. 13 of recurrence hip fracture in the left, and 8 in the right; there were ：femoral neck fracture in 14 and 7 for intertrochanteric fracture. Garden Ⅲ type 6 cases, Ⅳ type 8 cases for Femoral neck fracture. For intertrochanteric fracture, Evans-Jensen Ⅱ A type in 1, ⅡB type in 1, Ⅲ type in 5. All the femoral neck fracture patients adopt prosthesis replacement, 12 bone cement type artificial femoral head prosthesis among them. For the intertrochanteric fracture, 5 internal fixation （DHS 1, PFNA 4）, 2 femoral head prosthesis used customized artificial femoral bone cement type. All received follow-up for （16.82 ± 5.17） months after the operation for the second fracture. 5 died. At the time of the last follow-up, Harris hip function score was （94.41 ± 3.59） and （90.73 ± 7.62） （P 〉0.05） for the continuous two fractures. There were no major complications such as nonunion, prosthetic loosening, breakage of implants or infection. [Conclusion] Different surgical methods should be chosen on the basis of the prevention and treatment of basis of disease and osteoporosis for the contralateral hip fracture after hip prosthesis replacement for the aged. Recurrence of femoral neck fracture preferred bone cement type femoral head replacement; although inteItrochanteric fracture preferred internal fixation, prosthesis replacement was also feasible.