老年重度移位股骨颈骨折的人工关节类型的选择

Selection of the prostheses for the elderly patients with severe displaced fracture of the femoral neck

目的回顾性临床研究,对比双动人工股骨头和全髋关节置换术在此类骨折应用的结果,探讨假体选择的原则。方法自1986年1月～2000年12月,101例GardenⅢ,Ⅳ型股骨颈骨折行双动人工股骨头置换术(A组,55例)及全髋人工关节置换术(B组,46例)获得随访,A组为4.9年(1～10年),B组为3.5年(1.5～5年)。患者年龄A组为70.4(55～94岁),B组为69.5岁(57～75岁)。按Harris及MerledAubigue标准进行关节功能评分,并比较围手术期的并发症。结果关节功能的优良率,A组为78.12%,B组为95.65%(P<0.01)。表现为腹股沟和大腿痛A组>B组(A36.36%,B6.52%)关节屈曲活动受限(A85°,B110°)股骨柄下沉A组多见。围手术期并发症两组相似。结论老年重度移位骨折,如患者情况和术者技术允许,全髋关节置换术应为首选。双动人工股骨头置换宜保留给年老(>75岁),伤前活动量小及有较严重内科基础病者。

Objective To explore the selection of prostheses for the elderly patients with severe displaced fracture of the femoral neck through retrospective comparison of the long term clinical results between bipolar hemiarthroplasty and total hip replacement. Methods From January 1986 to December 2002, 101 cases of Garden Ⅲand Ⅳtypes of the femoral neck fracture were treated with either bipolar hemiarthroplasty (Group A: 55 cases) or total hip replacement (Group B: 46 cases). The age of the patients at the time of operation ranged from 55 to 94 years old (mean: 70.4 years old) in Group A, and from 57 to 75 years old (mean 69.5 years old) in Group B. The average period of follow up was 4.9 years (1 to 10 years) in Group A and 3.5 years (1.5 to 5 years) in Group B. The clinical results were evaluated according to Harris and Merle d'Aubigue criteria. The perioperative complications were compared. Results The excellent and good clinical results were 78.12 %in Groups A and 95.65 %in Group B respectively. The rate of groin and thigh pains was higher in Group A (36.36 %) than in Group B (6.52 %). The flexion of the hip in Group A was more limited (mean 85 degrees) than in Group B (mean 110 degrees). There were more cases of sunken femoral stem in Group A. The perioperative complications were similar in both groups. Conclusions The total hip arthroplasty is the first choice for the elderly patients with severe displaced femoral neck fracture if the conditions of the patient and the skills of the surgeon permit. The bipolar hemiarthroplasty is suitable for patients of more than 75 years old, or for those with severe diseases.