重建粗隆及股骨矩关节置换治疗高龄不稳定粗隆间骨折

目的探讨高龄不稳定型股骨粗隆间骨折人工关节置换的治疗效果。方法 2004年3月至2009年12月对38例高龄股骨粗隆间骨折行股骨粗隆、股骨矩修复重建人工关节置换术。患者年龄78～91岁,平均83.6岁,按Evans-Jensen分型均为不稳定型骨折,所有病例都合并有内科疾病及骨质疏松。术后早期康复训练。结果住院期间无一例死亡,37例于术后2周内下床负重,均获得3～36个月随访,无骨不愈合、关节感染、关节脱位、假体松动、下肢深静脉血栓形成等并发症,3例于术后5～13个月死于其他疾病。术后6个月按Harris髋关节功能评分标准,髋关节功能优良者31例。结论股骨粗隆、股骨矩重建人工关节置换治疗不稳定型股骨粗隆间骨折具有卧床时间短、可早期负重、髋关节功能恢复快、术后并发症低的优点,对高龄不稳定型股骨粗隆间骨折是一种较合理的治疗方法。

Analysis Hip Prosthesis Replacemen by Rebuilding Femoral Trochanteric and Femoral Calcar in Treating Unstable Femoral Intertrochanteric Fractures in Senile Patients

Objective To study the clinical effect of treatment of unstable intertrochanteric fracture of femur in the Senile patients with hip prosthesis replacement.Methods 38 patients with unstable femoral intertrochanteric fractures aged between 78～91 years old（average 83.9 years old） were treated by Hip Prosthesis replacemen by Rebuilding Femoral Trochanteric and Femoral Calcar.According to the fracture classification of Evans-Jensens,all of them belonged to unstable intertrochanteric fracture.All patiences suffered from both medical illness and osteoporosis.The patients did earliest rehabilitation exercise after operation.Results All patients succeeded in operation,No one died during the period of hospitalization,37 cases of them did weight bearing after 2 weeks from the operation.Follow-up for 3～36 months was performed in 38 patients,No delayed fracture healing and bone nonunion、joint infection and loosening、deep veinous thrombosis happened.Three patients died of other diseases 5～13 months after discharge from hospital.According to the the Harris scoring system,the function of hip joints was satisfactory in 31 patients 6 months after operation.Conclusion This treatment of unstable intertrochanteric fracture of femur with hip prosthesis replacement by rebuilding femoral trochanteric and femoral calcar in the senile patients has the virtue of shorter bed rest,.faster recovery of the foundation of hip joint and lower risk of complications and mortality.So it is a reasonable method to unstable femoral intertrochanteric fractures in senile patients.