生物型加长柄人工股骨头置换术治疗高龄不稳定性股骨转子间骨折的中期疗效分析

Analysis of mid-term efficacy of biological type long-stem artificial caput femoris replacement operation in the treatment of unstable senile intertrochanteric fracture

目的：探讨生物型加长柄人工股骨头置换术治疗高龄不稳定性股骨转子间骨折的中期疗效。方法应用生物型加长柄人工股骨头置换术治疗高龄不稳定性股骨转子间骨折73例，其中64例获得随访。术后3个月，依据Berg平衡量表将随访患者分为A、B、C、D四个等级，将符合A、B、C三个等级的54例患者纳入中远期随访研究。其中男25例，女29例，年龄73～94岁，平均81．6岁。骨折类型按Evans-Jensen分型：Ⅱ型28例，Ⅲ型26例。结果54例术后随访24～78个月，平均42个月。随访期间9例死亡，无转子部骨折块不愈合、股骨假体松动、髋关节脱位发生，3例钢丝有移位现象，4例患者出现髋臼磨损，3例出现异位骨化，1例发生假体周围骨折。按Engh标准评定股骨假体均获骨性固定。髋关节功能按Harris评价标准：优23例，良17例，优良率88．9％。结论应用生物型加长柄人工股骨头置换术治疗高龄不稳定性股骨转子间骨折可以获得满意的中期疗效。

Objective To explore the mid-term efficacy of biological type,long-stem artificial caput femo-ris replacement operation in the treatment of unstable senile intertrochanteric fracture.Methods 73 patients accepted the treatment of biological type long-stem artificial caput femoris replacement operation,and 64 cases were followed. After 3 months of operation,these 64 patients were divided into four groups which marked as A,B,C and D according to the Berg balance scale（BBS）.Accordingly,54 patients that in grade A,B and C would be brought into in long-term follow-up study.54 cases include 25 male patients and 29 female patients with an average age of 81.6 years old who aged from 73 to 94 years old.According to Evans-Jensen classification,28 cases were Evans-JensenⅡand the left 26 cases were Evans -JensenⅢ.Results The follow-up period was in the range of 24 to78 months （mean 42months）.During this period,except the 9 death cases,there was no case of femoral trochanteric ununited fracture, femoral prostheses loosening or dislocation of hip joint.In total,3 cases occurred with loss of fixing wire,4 cases occurred with acetabular wear,one case was experienced prosthesis adjacent fracture and three cases of heterotopic ossification.According to the Engh standard,all femoral prostheses got osseous fixation.The rate of excellent and good result were 88.9%with in which excellent in 23 cases and good in 17 cases.Conclusion The application of biological type long-stem artificial caput femoris replacement in the treatment of unstable senile intertrochanteric fracture can achieve satisfactory mid-term efficiency.