人工关节置换联合粗隆及股骨矩重建治疗高龄股骨粗隆间粉碎性骨折

Artificial joint replacement combined with coarse and femoral reconstruction in the treatment of intertrochanteric comminuted fracture in elderly patients

目的：探讨人工关节置换联合粗隆及股骨矩重建治疗高龄股骨粗隆间粉碎性骨折的疗效。方法回顾性分析2011年1月至2014年5月应用人工关节置换联合粗隆及股骨矩重建治疗的74例高龄股骨粗隆间粉碎性骨折患者的临床资料，男40例，女34例，年龄75～93岁，平均82.5岁；骨折按 Evans-Jensen 分型：I 型25例，IV 型34例，V 型15例，X 线片观察骨折愈合及假体情况，Harris 髋关节评分评估髋关节功能。结果74例患者手术时间平均57 min（45～85 min），术中出血量330 ml（200～580 ml）。所有患者均手术顺利，无切口感染、关节脱位等并发症。住院期间发生肺部感染2例，急性左心力衰竭竭1例，下肢深静脉血栓形成2例，脑梗死2例，住院期间无一例患者死亡。5例患者在随访期间死亡，69例获得完整随访，随访时间平均28个月（12～40个月），术后6个月时骨折均愈合良好，末次随访时未见假体松动、下沉现象，Harris 评分平均86.5分（48～95分）。优29例，良31例，可7例，差2例，优良率为87.0％。结论人工关节置换联合粗隆及股骨矩重建是治疗高龄股骨粗隆间粉碎性骨折的一种有效方法，近期疗效满意，具有可早期下地负重活动、并发症少的优点。

Objective To investigate the effect of artificial joint replacement combined with coarse and femoral reconstruction on intertrochanteric comminuted fracture in elderly patients. Methods From January 2011 to May 2014,74 elderly patients with comminuted femoral intertrochanteric fractures were treated by hip joint replacement. There were 40 males and 34 females,aged 73-93 years （82. 5 years in average）. According to classification of Evans-Jensen,there were 25 cases of type Ⅲ,34 cases of type IV and 15 cases of type V. Through applying X-ray to observe fracture healing and prosthesis, using Harris hip score to evaluate the curative efficiency. Results The mean oprative time was 57 min （45-85 min）;the mean blood loss was 330 ml（200-580 ml）. All patients were successfully operated, no wound infection or dislocation. The complication included two cases of infection of the pulmonary infection,one case of left heart failure,two cases of deep venous thrombosis,two cases of cerebral infarction after opration. No case died in hospitalization. Five cases died during the follow-up period. Sixty-nine cases were followed up for 12 to 40 months（28 months in average）. The fracture healed in six months postoperatively. According to Harris scoring system to evaluate the efficacy at last follow-up,the results showed excellent in 29 cases,good in 31 cases,fair in seven cases and poor in two cases,the overall rate of excellent or good result was 87. 0% . Conclusions Treatment of hip joint replacement by rebuilding femoral trochanteric and femoral calcar for comminuted femoral intertrochanteric fractures in elderly patients have satisfactory short-term efficacy.