加长柄半髋关节置换治疗高龄股骨转子间骨折的临床观察

Effect Analysis on Bipolar Hemiarthroplasty with Long Handle for Femoral Intertrochanteric Fractures in the Elder Patients

目的观察加长柄半髋关节置换术治疗高龄骨质疏松患者不稳定股骨转子间骨折的临床疗效。方法回顾性分析2000年4月-2014年4月我科收治的46例高龄、不稳定股骨转子间骨折患者临床资料,平均年龄83.3（73-96）岁。骨折Evans分型：ⅢA型6例,ⅢB型17例,Ⅳ21例;钢板螺钉内固定术后钢板断裂2例。术中复位骨折后于正常位置行常规股骨颈截骨,保留股骨距部分骨质,置入双极型加长柄半髋关节。结果本组患者均顺利完成手术,手术时间平均68（60-80）min,术中输血平均350（0-600）ml。本组无一例死亡,无伤口感染,平均住院时间16（10-24）d,未出现肺栓塞或呼吸道、泌尿系感染等。术后常规复查X线片,假体位置良好,骨折复位满意。术后平均随访24个月（6个月-4年）。随访中发现转子间骨折35例于两年内愈合,6例随访1年见骨痂形成,但仍可见骨折线,5例骨折未见明显愈合迹象,假体均未见松动下沉。术后Harris评分优36例,良7例,可3例,优良率93.5%。结论加长柄人工半髋关节置换术治疗高龄股骨转子间骨折疗效确定,患者可早期下床活动,缩短住院周期,并发症减少,是可靠的治疗方式。

Objective To observe the clinical curative effect of bipolar hemiarthroplasty with long handle in the treatment of unstable femoral intertrochanteric fractures in the elder osteoporosis patients. Methods The clinical data of 46 osteoporosis patients,aged from 73 to 96 years old（ mean 83. 3）,with unstable femoral intertrochanteric fracture admitted from April 2000 to April 2014 were analyzed retrospectively. After reduction,conventional femoral neck osteotomy were performed and part of femoral calcar was retained,following bipolar hemiarthroplasty with long handle were carried out. Results All cases were accomplished the surgery. The operative time was 60 to 80 minutes with an average of 68 minutes,and the intra-operative blood transfusion volume was 0 to 600 ml with an average of 350 ml. No peri-operative death or incision infection was found. The average hospitalization was 16 days（ ranged from 10 to 24 days）. There was no post-operative complication as pulmonary embolism,respiratory infection and urinary infection occurred. The X ray exam showed both prosthesis position and fracture reductions were satisfied. All cases were followed up for 24 months（ ranged from 6months to 4 years）. No prothesis loosening was found in all 46 cases. The Harris score revealed excellence in36 cases,good in 7 cases and fair in 3 cases,and the fineness rate was 93. 5%. Conclusion For elderly patients with unstable femoral intertrochanteric fracture,the bipolar hemiarthroplasty with long handle is an effective and reliable treatment with early ambulation,shorten hospitalization and fewer complications.