圆锥形生物翻修柄髋关节置换治疗90岁以上高龄患者Dorr C型股骨髓腔的髋部骨折

Hip arthroplasty with uncemented Wagner SL revision stem for treatment of hip fractures with Dorr type C femoral canals in patients older than 90 years

[目的]探讨应用圆锥形生物翻修柄髋关节置换治疗90岁以上高龄患者Dorr C型烟囱状髓腔髋部骨折的近期临床疗效。[方法]2009年8月~2014年3月采用圆锥形生物翻修柄对15例90岁以上高龄患者Dorr C型烟囱状髓腔的髋部骨折进行髋关节置换。男10例,女5例;年龄90~99岁,平均94.2岁。股骨颈骨折12例,股骨转子间骨折3例。正位X线片上股骨近段髓腔形态均为Dorr C型,采用Wagner SL生物翻修柄术后行髋关节置换,其中半髋置换13例,全髋置换2例。术后X线片检查股骨假体位置并评价骨-假体界面稳定性,应用Harris评分标准评价髋关节功能。[结果]全部病例获得随访,随访时间12~48个月（平均32.5个月）。术后即刻X线片均显示股骨柄与髓腔紧密压配,假体髓腔填充良好,Harris髋关节评分为从术前的（33.5±9.6）分提高至术后6个月随访时的（85.8±3.2）分。术后6个月X线片上根据Engh骨长入标准,13例骨长入,2例为稳定纤维长入。3例主诉有轻微大腿痛。[结论]生物型髋关节置换是治疗超高龄患者髋部骨折的有效方法。圆锥形生物翻修柄可良好充填老年人股骨近端粗大烟囱状髓腔,并可有效避免骨水泥对老年人心血管带来的潜在危险。

[ Objective ] To investigate the short - term clinical efficacy of hip arthroplasty with uncemented Wagner SL revi- sion stem in the treatment of hip fractures with Dorr type C stovepipe - shaped femoral canals in patients older than 90 years. [ Method] From August 2009 to March 2014, hip arthroplasty with uncemented Wagner SL revision stem was used to treat 15 patients older than 90 years with hip fractures who had Dorr type C stovepipe - shaped femoral canals. These patients, consisting of 10 males and 5 females,were aged from 90 to 99 years （mean 94.2 years）. Twelve out of the patients had femoral neck frac- tures and three femoral intertrochanteric fractures. According to the posteroanterior radiograph, the proximal femoral canal was morphologically classified as Dorr type C. All patients were treated with uncemented Wagner SL revision stem followed by hip ar- throplasty. Thirteen out of the patients underwent hip hemiarthroplasty and two total hip arthroplasty. Postoperative radiography was performed to analyze the location of femoral prostheses and evaluate the stability of the bone - prosthesis interface. Harris score was used to evaluate the hip function. [ Result] All patients were followed up for 12 -48 months （mean 32.5 months）. The radiographic analysis immediately after surgery showed that femoral stems and canals were tightly packed together and pros- thesis canals were well filled. The Harris hip score was improved from preoperative 33.5 _＋ 9.6 to 85.8 ＋ 3.2 at 6 months after surgery. The radiography at 6 months after surgery demonstrated good osseointegration in 13 patients and stable fibrosis in 2 pa- tients ,according to Enghg criteria. Three patients reported slight thigh pain. [ Conclusion] Uncemented hip arthroplasty is effec- tive in the treatment of hip fractures in extremely elderly patients. The Wagner SL revision stem can well fill Dorr type C femoral canals in elderly patients and avoid the potential risk of cardiovascular arrest in elderly patients caused by bone cement.