双极人工股骨头置换治疗老年人偏瘫侧股骨颈骨折

Bipolar hemiarthroplasty for hemiplegic side femoral neck fractures in elderly patients

目的评估双极人工股骨头置换术治疗老年偏瘫侧股骨颈骨折的可行性和有效性。方法选取2012年至2015年于北京同仁医院手术治疗的偏瘫侧股骨颈骨折患者为研究对象。评估患者末次随访时的Harris评分和Barthel指数评分，记录患者术后的脱位、深静脉血栓、髋部感染等并发症情况。结果纳入研究共25例患者，平均年龄70．1岁，随访10～42个月，平均随访24．3个月。所有患者无伤口及深部组织感染发生，未发现下肢深静脉血栓形成，未出现髋关节脱位，无因各种原因导致的翻修。患者术前Barthe1指数评分为15～35分，平均（25．0±6．0）分。术后随访时为40～95分，平均（77．4±14．7）分，明显高于术前（t=-21．374，P〈O．05）。随访时患者Harris评分为60～95分，平均（83．5±8．9）分。根据Harris评分标准，优良率72．0％。患者满意率88．0％。结论选择合适的假体和固定方式，术中注意保留短外旋肌功能、恢复外展肌张力，对老年患者偏瘫侧股骨颈骨折进行人工股骨头置换手术治疗可以取得满意的疗效。

Objective The feasibility and the curative effect of bipolar hemiarthroplasty for hemiplegic side femoral neck fractures in elderly patients were evaluated. Methods The patients suffering from hemiplegie side femoral neck fractures and undergoing bipolar hemiarthroplasty in Beijing Tongren Hospital were followed up during 2012 - 2015. The postoperative Harris Score and the complications such as infection, deep vein thrombosis and dislocation were collected. Results Totally 25 patients（25 hips）were followed-up. The average age was 70.1 years, and mean follow-up period was 24.3 months （ 10 - 42 months）. The mean Barthel index score was higher （ 77.4 ± 14.7, ranging from 40-95 points） after operation than before operation[25.00± 5.95 （15 35 points）] with a statistically significant difference（t=-21. 374 ,P〈0.05）. The postoperative Harris Score was 83.5± 8.9（60-95 points）. According to Harris score,the excellent and good rate was 80.0%. The patient＇s satisfaction rate was 88.0%. Conclusions Choosing proper prosthesis and fixing measure, and keeping the function and tension of short extorsion muscles can achieve the satisfactory results for hemiolegic side femoral neck fractures in elderly patients.