Arthroplasty vs proximal femoral nails for unstable intertrochanteric femoral fractures in elderly patients: a systematic review and metaanalysis

BACKGROUND Proximal femoral nails(PFNs)are the most common method for the treatment of unstable intertrochanteric femoral fractures(IFFs),but postoperative bed rest is required.There is a large amount of blood loss during the operation.Osteoporosis in elderly patients may cause nonunion of fractures and other complications.Arthroplasty can give patients early weight bearing and reduce financial burden,but whether it can replace PFNs remains controversial.AIM To compare the clinical outcomes of arthroplasty and PFNs in the treatment of unstable IFFs in elderly patients.METHODS A search was conducted in the PubMed,Embase,and Cochrane Library databases and included relevant articles comparing arthroplasty and PFN.The search time was limited from January 1,2005 to November 1,2020.Two investigators independently screened studies,extracted data and evaluated the quality according to the inclusion and exclusion criteria.According to the research results,the fixed effect model or random effect model were selected for analysis.The following outcomes were analyzed:Harris Hip score,mortality,complications,operation time,blood loos,hospital stay,weight-bearing time,fracture classification and type of anesthesia.RESULTS We analyzed four randomized controlled trials that met the requirements.A total of 298 patients were included in these studies.According to the AO/OTA classification,there are 20 A1 types,136 A2 types,42 A3 types and 100 unrecorded types.Primary outcome:The Harris Hip Score at the final follow-up of the PFN group was higher[mean difference(MD):9.01,95%confidence interval(CI):16.57 to 1.45),P=0.02].There was no significant difference between the two groups in the rate of overall mortality[risk ratio(RR):1.44,P=0.44]or the number of complications(RR:0.77,P=0.05).Secondary outcomes:blood loss of the arthroplasty group was higher(MD:241.01,95%CI:43.06–438.96,P=0.02);the operation time of the PFN group was shorter(MD:23.12,95%CI:10.46–35.77,P=0.0003);and the length of hospital stay of the arthroplasty group was shorter[MD:0.97,95%CI:1.29 to 0.66),P<0.00001].There was no difference between the two groups in the type of anesthesia(RR:0.99).There were only two studies recording the weight-bearing time,and the time of full weight bearing in the arthroplasty group was significantly earlier.CONCLUSION Compared with PFN,arthroplasty can achieve weight bearing earlier and shorten hospital stay,but it cannot achieve a better clinical outcome.Arthroplasty cannot replace PFNs in the treatment of unstable IFFs in elderly individuals.

Therapeutic Effect of Artificial Femoral Head Replacement and Proximal Femoral Nail Antirotation on Elderly Unstable Intertrochanteric Fractures

Objective: To compare the clinical efficacy of artificial femoral head replacement and Proximal femoral nail antirotation (PFNA) in the treatment of unstable femoral intertrochanteric fractures in the elderly. Methods: This study retrospectively analyzed 60 elderly patients with unstable intertrochanteric fractures treated with PFNA and artificial femoral head replacement from 2015.06 to 2018.06, of which 34 were in the PFNA group (Group A) and 26 in the artificial femoral head replacement group (Group B). Statistical analysis of relevant surgical indicators such as surgical time, intraoperative blood loss, postoperative blood transfusion, postoperative time to landing, postoperative infection rate, hospital stay, number of secondary operations, postoperative VAS score, and postoperative Hip function score comparison. Results: All 60 patients were followed up for 1 - 24 months. Compared with the artificial femoral head replacement group, the operation time of PFNA group was shorter, the blood loss during operation was less, and the difference was statistically significant (P 0.05). Conclusion: The hip joint function and pain scores of the artificial femoral head replacement group in the early and follow-up periods are better than those of the PFNA group. The artificial femoral head replacement is more suitable for the treatment of elderly unstable intertrochanteric fractures.

A comparison of three fixations for intertrochanteric femoral fractures in the elderly

Objective To compare the efficacy of 3 internal fixations,locking proximal femoral plate (LPFP),ASI-AN IMHS and InterTAN,for intertrochanteric femoral fractures in elderly patients.Methods A retrospective study was done to analyse

Control study of short-term curative effect of minimally invasive total hip arthroplasty using metal-on-metal large-diameter femoral head for the elderly patients with femoral neck fractures

Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the elderly patients

Hidden blood loss after intertrochanteric fractures in elderly patients and its influence on the postoperative function recovery:a random controlled trial

Objective To investigate hidden blood loss after various types of intertrochanteric fractures and to determine whether oral iron supplementations is benefical for the postoperative functional recovery in elderly patients.Methods From

Comparison of Proximal Femoral Geometry and Risk Factors between Femoral Neck Fractures and Femoral Intertrochanteric Fractures in an Elderly Chinese Population

Background： Few studies have investigated the differences in proximal femoral geometry and risk factors between patients with different types of hip fracture, especially in elderly Chinese. This study aimed to assess the differences in proximal femoral geometry parameters between patients with femoral neck fractures and patients with intertrochanteric fractures to provide guidance for individualized customized prosthesis and accurate reconstruction of proximal femurs in elderly Chinese patients. Methods： We retrospectively studied the electronic medical records of 198 elderly patients over 65 years of age who were admitted to the orthopedic department with hip fractures between January 2017 and December 2017 in The Third Hospital, Hebei Medical University. Age, fracture site, gender, and proximal femoral geometry parameters （.neck shaft angle [NSA], center edge angle [CEA], femoral head diameter [FHD], femoral neck diameter [FND], femoral neck axial length [FNAL], hip axial length [HAL], and femoral shaft diameter [FSD]） were recorded. Student＇s t-test was used to compare the continuous variables, Chi-square test was used to analyze categorical variables, and multiple logistic stepwise regression analysis was used to evaluate the influencing factors of hip fracture type. Results： Statistically significant differences in NSA （137.63 ± 4.56° vs. 132.07 ± 4.17°, t = 1.598, P 〈 0.001）, CEA （37.62 ± 6.77° vs. 43.11 ±7.09°, t = 5.597, P 〈 0.001 ）, FND （35.21 ± 3.25 mm vs. 34.09 ±3.82 mm, t = 2.233, P = 0.027）, and FNAL （99.30 ± 7.91 mm vs. 103.58± 8.39 ram, t = 3.715, P 〈 0.001 ） were found between the femoral neck fracture group and femoral intertrochanteric fracture group. FHD, FND, FSD, HAL, and FNAL were different between sexes （all P 〈 0.001 ）. The greater NSA was the risk factor for femoral neck fractures （,odds ratio [OR]： 0.70, P 〈 0.001 ）, greater CEA and longer FNAL were risk factors for femoral intertrochanteric fractures （OR： 1.15, 1.17, all P 〈 0.001）, and greater FND was a protective factor for femoral intertrochanteric fractures （OR： 0.74, P 〈 0.001）. Conclusions： We demonstrate differences in geometric morphological parameters of the proximal femur in different hip fracture types, as well as an effect of sex. These differences should he considered in the selection of prostheses for fracture internal fixation and hip replacements. These data could help guide the design of individualized customized prostheses and improve the accurate reconstruction of the proximal femur for elderly Chinese hip fracture patients.

InterTan髓内钉与股骨近端防旋髓内钉治疗老年性股骨粗隆间骨折的Meta分析

目的通过meta分析评价股InterTan髓内钉与骨近端防旋髓内钉(PFNA)治疗老年股骨粗隆间骨折的疗效差异,评估两种手术方法的优劣。方法通过计算机检索Pubmed、Medline、Cochrane Library等外文数据库和万方、知网、维普等中文数据库中2014年10月至2017年6月发表的比较InterTan与PFNA治疗老年股骨粗隆间骨折疗效的随机对照及回顾性队列研究的相关文献,比较InterTan组与PFNA组的手术时间、术中出血量、骨性愈合时间、Harris功能评分优良率、术后尖顶距(TAD)、术后总体并发症、内固定失败率、切口感染率、骨折不愈合率。由2位系统评价员做独立的文献筛查、资料提取和质量评价,采用Rev Man5.3软件进行meta分析。结果共纳入10篇文献918例患者,其中InterTan组472例,PFNA组446例。PFNA组手术时间、术中出血量均低于InterTan组(P均<0.05),两组骨性愈合时间、术后随访Harris评分、术后TAD、切口感染率、骨折不愈合率比较差异均无统计学意义(P均>0.05)。InterTan组术后总体并发症发生率、内固定失败率少于PFNA组,两组比较差异有统计学意义(P<0.05)。结论 PFNA和InterTan系统治疗老年股骨粗隆间骨折均可取得良好效果,建议身体条件差和不能耐受长时间手术的患者可选择PFNA治疗,否则,InterTan系统治疗是更好的选择。

应用InterTan与PFNA治疗老年患者股骨粗隆间骨折疗效分析

目的探讨老年股骨转子间骨折两种髓内固定方法（Inter Tan与PFNA）的临床效果。方法回顾2011年~2012年在我院收治的老年股骨粗隆间骨折患者中,随机选取应用两种内固定方法治疗病例60例,其中33例应用Inter Tan治疗,27例应用PFNA治疗。结果 60例患者均得到随访,时间12~28个月,平均18.5个月,无死亡个案,Inter Tan组：手术时间为（65.2±15.5）min,术中出血量为（261.5±110.7）ml,下地行走时间为（5.3±0.8）周,骨折愈合时间为（8.8±1.3）周;PFNA组：手术时间为（40.4±16.1）min,术中出血量为（192±120.6）ml,下地行走时间为（5.0±0.6）周,骨折愈合时间为（8.6±0.8）周。在手术时间及术中出血量方面,两组差异有显著性意义,在下地行走时间及骨折愈合时间方面没有差异。结论 Inter Tan及PFNA均是治疗老年患者股骨粗隆间骨折的有效方法,但应用PFNA方法的病例,手术时间短,术中出血量更少。

Modified fixation for periprosthetic supracondylar femur fractures:Two case reports and review of the literature

BACKGROUND Periprosthetic supracondylar femoral fractures(PSFs)present a challenge in terms of optimizing fixation in patients with poor bone quality.Surgical treatment and peri-operative management of PSFs in the elderly remain a burden for orthopedic surgeons.Among different treatment options,locking plate(LP)and retrograde intramedullary nail(RIMN)have shown favorable results.However,reduced mobility and protected weight-bearing are often present in the postoperative older population.With a purpose of allowing for early weight-bearing,a modified nail plate combination(NPC)was redesigned for PSF management.CASE SUMMARY In our cases,two elderly osteoporotic female underwent total knee arthroplasty(TKA),and then suffered from low energy trauma onto their knees after falling to the floor.Plain radiographs or computed tomography scans demonstrated oblique or transverse PSFs,both of which occurred at the distal femur above TKA.The modified NPC technique was performed for treatment of PSFs.The patient was made foot flat weight bearing in 1 wk.At 6-mo follow-up,the union was ultimately achieved using modified NPC with satisfactory implant outcomes.CONCLUSION Neither LP nor RIMN alone may provide adequate support to allow for union in circumstances where the patient has severely osteopenic bone.Therefore,developing a modified implant offer an alternative choice for treating PSFs.These two cases revealed that this technique is a viable option for the geriatric osteoporotic PSFs,offering safe,early weight bearing and favorable clinical outcomes.

老年髋部骨折术前等待时间对术后骨折愈合时间的影响

目的根据江苏大学附属句容医院临床收治的老年髋部骨折患者数据进行分析,来评估老年髋部骨折患者术前等待时间是否对术后骨折愈合时间有影响。方法通过收集2017年9月至2022年11月江苏大学附属句容医院老年髋部骨折的病例资料,筛选出确诊且接受手术治疗的老年髋部骨折患者108例,根据术前等待时间不同,分为早期手术组(60例)和延期手术组(48例),分析两组患者的年龄,性别,住院时间,术后骨折愈合时间是否有区别。结果早期组骨折愈合时间上短于延期组,差异有统计学意义(P<0.05);两组的手术操作时间、手术中出血量、性别、年龄比较,差异无统计学意义(P>0.05)。结论老年髋部骨折患者应在骨折48 h内尽早接受手术,有助于缩短骨折愈合时间,从而减少并发症的发生。

PFNA与髋关节置换术治疗老年人股骨粗隆间骨折的临床研究

目的:探究老年股骨粗隆间骨折患者应用股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)与髋关节置换术的治疗效果。方法:回顾性分析2020年1月—2022年9月于景德镇市第二人民医院骨科确诊的老年粗隆间骨折患者60例的临床资料。依据手术方法不同分为PFNA组(30例)及关节置换组(30例)。PFNA组行PFNA术治疗,关节置换组采用髋关节置换术治疗。对比两组围手术期指标、髋关节优良率、并发症发生率。结果:相比于关节置换组,PFNA组手术时间及住院时间均较短,术中出血量较少,差异均有统计学意义(P<0.05)。相比于关节置换组,PFNA组术后14 d、术后3个月髋关节优良率均较高,差异均有统计学意义(P<0.05);术后6个月,两组髋关节功能优良率及并发症发生率对比,差异均无统计学意义(P>0.05)。结论:两种术式在股骨粗隆间骨折患者治疗中均可获得理想效果,能够有效恢复患者髋关节功能。在手术方式选择中则需依据患者病情进行判断,以选择最佳的手术方式,获得理想的手术效果。

营养状况、骨代谢及股骨颈强度指数和骨髓脂质分数与老年髋部骨折术后关节功能恢复的关系研究

目的探究营养状况、骨代谢及股骨颈强度指数(FSI)和骨髓脂质分数(LF)与老年髋部骨折术后关节功能恢复的关系。方法选取2021年6月至2023年6月于原阳县中心医院接受治疗的髋部骨折手术老年患者160例为研究对象。根据患者髋关节功能恢复情况进行分组,恢复良好患者87例纳入良好组,恢复不良患者73例纳入不良组。对比两组患者一般资料、营养状况、骨代谢及FSI和LF。结果良好组年龄≥75岁比例、体重、体质量指数(BMI)、股骨粗隆间骨折比例、Ⅰ型胶原蛋白N端肽(NTX)、抗酒石酸酸性磷酸酶5b(TPACP-5b)水平表达均低于不良组,差异均有统计学意义(P<0.05);良好组微型营养评定(MNA)评分、FSI、LF、骨钙蛋白(BGP)水平表达均高于不良组,差异均有统计学意义(P<0.05);经Logistic回归分析,MNA评分、LF、FSI、NTX、TPACP-5b、BGP水平表达均为影响老年髋部骨折术后关节功能恢复情况的独立危险因素,差异有统计学意义(P<0.05);经受试者工作特征(ROC)曲线分析,MNA评分、FSI、LF、NTX、TPACP-5b水平表达均对老年髋部骨折术后关节功能恢复情况有较高的预测价值,曲线下面积(AUC)值分别为0.936、0.874、0.866、0.884、0.825;BGP水平表达的AUC值为0.634,可作为次要参考。结论观察行髋部骨折手术的老年患者术后营养状况、骨代谢及股骨颈强度指数和骨髓脂质分数的变化情况,有利于早期预测患者术后髋关节功能恢复情况,从而制定相应防控措施,帮助患者早日康复。

机器人辅助近端防旋髓内钉内固定治疗老年股骨粗隆间骨折预后不良的预测研究及策略分析

目的:探讨老年股骨粗隆间骨折(IFOF)患者行机器人辅助股骨近端防旋髓内钉(PFNA)内固定治疗预后不良的影响因素及应对策略。方法:选取2022年5月—2024年5月宝鸡市中心医院行机器人辅助PFNA内固定手术的老年IFOF患者136例。根据术后12个月Harris髋关节功能量表评分结果,分为预后良好组(≥80分)与预后不良组(<80分)。采用单因素、多因素Logistic回归分析预后不良危险因素,建立风险预测模型,分析模型价值并验证。结果:年龄偏高、术前美国麻醉医师协会(ASA)分级>Ⅱ级、骨折Ⅲ~Ⅳ型、术后引流量偏高、术后负重时间过长为老年IFOF患者预后不良的独立危险因素(P<0.05),风险预测模型曲线AUC值为0.978(95%CI:0.953~1.000),当取Cut-off值时,模型敏感度、特异度分别为0.927、0.963。Bootstrap内部验证显示该模型预测效能较为稳定,决策分析显示该模型有正向净收益率。结论:年龄偏高、术前ASA分级>Ⅱ级、骨折Ⅲ~Ⅳ型、术后引流量偏高、术后负重时间过长为老年IFOF患者行机器人辅助PFNA内固定手术治疗预后不良的独立危险因素,基于预后不良危险因素建立的风险列线图模型预测效能较好且稳定,可用于指导临床决策。

围手术期运动疗法护理在老年骨质疏松股骨转子间骨折患者中的应用效果及对骨折修复、生活活动自理能力的影响

目的分析围手术期运动疗法护理在老年骨质疏松股骨转子间骨折患者中的应用效果。方法选取2018年1月至2021年12月行手术治疗的98例老年骨质疏松股骨转子间骨折患者为研究对象,按随机数字表法将其分为对照组(n=49,常规围手术期护理)和观察组(n=49,在对照组基础上行运动疗法护理)。比较两组的干预效果。结果干预后,观察组的C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)水平均低于对照组(P<0.05)。观察组的并发症总发生率低于对照组(P<0.05)。术后1、3、6个月,观察组的Harris髋关节功能评分高于对照组(P<0.05)。术后6个月随访时,观察组的生活活动自理能力优于对照组(P<0.05)。结论围手术期运动疗法护理可有效减轻老年骨质疏松股骨转子间骨折患者的炎性因子水平,降低手术并发症发生率,提高生活活动自理能力,从而促进骨折修复。

股骨近端髓内钉内固定术和人工髋关节置换术治疗老年股骨转子间骨折的疗效对比

目的研究股骨近端髓内钉与人工髋关节置换治疗老年人股骨转子间骨折的疗效。方法选取2021年11月—2023年11月贵州省天柱县人民医院收治的60例股骨转子间骨折高龄患者为研究对象,按照手术方法不同将患者划分成髓内钉内固定术(proximal femoral nail antirotation,PFNA)组与人工全髋关节置换术(total hip arthroplasty,THA)组,各30例。比较两组围术期相关生理指标、并发症发生率、Harris髋关节功能评分、康复状况和生活质量。结果两组手术时间比较,差异无统计学意义(P>0.05)。PFNA组术中出血量少于THA组,住院时间、术后首次负重站立时间长于THA组,差异有统计学意义(P均<0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。THA组术后恢复优良率为93.33%(28/30),高于PFNA组的73.33%(22/30),差异有统计学意义(χ^(2)=4.320,P=0.037)。THA组的Harris髋关节功能评分、生活质量评分均优于PFNA组,差异有统计学意义(P均<0.05)。结论两种手术方案均表现出良好的临床效果,髓内钉内固定术操作相对简便,术中出血量较少,而人工髋关节置换术能缩短离床活动时间,对术后早期关节的活动改善效果更显著。

股骨近端防旋髓内钉对老年股骨转子间骨折患者骨代谢及骨强度指标的影响

目的 研究股骨近端防旋髓内钉(PFNA)治疗老年股骨转子间骨折的价值。方法 选取2019年1月至2023年7月我院收治的60例老年股骨转子间骨折患者为研究对象,根据随机数字表法将其分为对照组(n=30)和观察组(n=30)。对照组采用动力髋螺钉治疗,观察组采用PFNA治疗。比较两组的治疗效果。结果观察组的手术时间及骨折平均愈合时间均短于对照组,术中出血量少于对照组(P<0.05)。治疗后,观察组的视觉模拟量表(VAS)评分低于对照组,Harris髋关节功能评分(HHS)评分高于对照组(P<0.05)。治疗后,观察组的骨钙素(BGP)、Ⅰ型前胶原N端前肽(PⅠNP)水平高于对照组,Ⅰ型胶原C端肽(CTX-Ⅰ)水平低于对照组(P<0.05)。治疗后,观察组的白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)水平低于对照组(P<0.05)。治疗后,观察组的屈曲比率(BR)低于对照组,横截面转动惯量(CSMI)、骨密度(BMD)高于对照组(P<0.05)。观察组的并发症总发生率低于对照组(P<0.05)。结论 PFNA治疗老年股骨转子间骨折患者效果显著,能改善骨代谢、骨强度指标。

老年伴有并存症的股骨颈骨折髋关节置换疗效分析

[目的]评价老年有并存症的股骨颈骨折、髋关节置换及围手术期的治疗等问题。[方法]将1997年6月～2003年12月收治的486例,65岁以上有并存症,GardenⅢ、Ⅳ型股骨颈骨折患者,分别采用全髋关节置换术(THR)和半髋关节置换术(PR)。[结果]486例随访时间18～72个月,平均36.5±6.2个月,两组在并存症等级、手术时间[THR平均(80.5±20.6)min,PR平均(60.2±10.7)min],失血量[THR平均(380.4±150.6)ml,PR平均(230.5±120.2)ml]方面,差异显著(P<0.05)。功能评价按照Harris[1]评分标准,优良率[THR(92.6±1.5)%],PR[(86.2±1.6)%]有显著性差异(P<0.05)。[结论]根据并存症的等级情况,选择全髋或半髋关节置换是治疗伴有并存症的老年股骨颈骨折的较好的方法,有助于安全度过围手术期,恢复功能活动,提高患者生活质量。

老年股骨粗隆间骨折患者围术期并发症的分析

目的探讨髓内固定系统、髓外钉板系统对老年股骨粗隆间骨折患者围术期并发症的影响。方法回顾性分析523例行手术治疗的老年股骨粗隆间骨折患者的临床资料,比较术中应用髓内固定系统(髓内组,369例)和髓外钉板系统(髓外组,154例)患者围术期猝死、深静脉血栓形成、心血管疾病、肺栓塞、脑梗死等全身并发症发生情况,以及有无感染、褥疮等局部并发症发生。结果两组间性别、国际内固定研究协会/美国骨科创伤协会骨折分型、美国麻醉医师学会分级Ⅲ或Ⅳ级的构成比,以及年龄、手术时间、术中出血量、住院时间的差异均无统计学意义(P值均>0.05)。两组共60例患者发生全身和局部并发症,并发症发生率为11.5%(60/523)。髓内组中,40例患者发生并发症,全身并发症和局部并发症发生率分别为8.1%(30/369)和2.7%(10/369)。髓外组中,20例患者发生并发症,全身并发症和局部并发症发生率分别为9.7%(15/154)和3.2%(5/154)。两组间各种全身并发症和局部并发症发生率的差异均无统计学意义(P值均>0.05)。结论内固定治疗老年股骨粗隆间骨折的并发症发生率低,髓外钉板系统与髓内固定系统差异无统计学意义,但前者的局部并发症发生率有高于后者的趋势。

PFNA与PFN内固定治疗老年股骨粗隆间骨折的临床疗效评价

目的探讨PFNA(股骨近端抗旋髓内钉)与PFN(股骨近端重建钉)内固定治疗老年股骨粗隆间骨折的治疗效果。方法 2010年5月~2012年12月采用C臂透视下闭合复位PFNA内固定治疗老年股骨粗隆间骨折108例为PFNA组,随机选取同时期病例采用PFN内固定治疗老年股骨粗隆间骨折102例为PFN组,记录手术时间、术中出血量、手术前后血红蛋白值、术后完全负重时间、术后并发症及末次随访时患髋Harris评分,对二者的疗效进行回顾性分析比较。结果两组术后均随访8~24个月,PFNA组1例发生下肢深静脉血栓。全部病例未发生螺旋刀片骨内切割、松动移位,骨折全部愈合。PFN组6例发生髋部加压螺钉松动,其中骨折畸形愈合2例,2例行PFNA翻修治疗,2例行人工关节置换补救手术治疗。两组手术时间、术中出血量、术后血红蛋白值、术后完全负重时间、术后并发症比较差异有统计学意义(<0.05)。术前血红蛋白值、末次随访髋关节Harris评分无统计学意义(>0.05)。结论采用PFNA微创内固定治疗老年股骨粗隆间骨折可以减少医源性血运破坏、骨质丢失,操作简单、缩短手术时间、减少术中出血量,可有效固定骨折,减少并发症,有利于骨折愈合,临床疗效满意,是老年股骨粗隆间骨折理想的治疗方法。

老年人股骨颈骨折髋关节置换疗效分析

目的 :评价老年人股骨颈骨折髋关节置换临床疗效 ,探讨有关假体选择、并发症、手术时机把握等问题。方法 :回顾分析 1995～ 2 0 0 2年收治的 62例 70岁以上老年人股骨颈骨折应用髋关节置换的治疗方法及效果。结果 :随访 2 2～ 96个月 ,按照Harris[1] 评分标准进行评估显示 ,本组优良率为 83 .9%。全髋置换组明显优于半髋组 ,优良率为 93 .9% ,半髋组则为 46.2 %。结论 :(1)在并存症得到控制稳定后 ,及时地根据病人伤前生活质量来选择全髋或半髋置换是治疗高龄股骨颈骨折的首选方法 ;(2 )强调术中注意观察及处理麻醉开始、扩髓与灌注骨水泥这三个时段病情的变化 ;(3 )陈旧性股骨颈骨折病人术前不适宜牵引。