非骨水泥型人工关节置换治疗老年不稳定股骨转子间骨折

 目的 探讨非骨水泥型人工关节置换治疗老年不稳定型股骨转子间骨折的手术技术和疗效。方法 回顾性分析2003 年12 月至2011 年5 月采用非骨水泥型全涂层矩形柄行人工髋关节置换术治疗23例老年不稳定型股骨转子间骨折的资料, 男6 例, 女17 例;年龄73~95 岁, 平均77.6 岁。骨折按Evans-Jensen 分型: IIA 型2 例, IIB 型9 例, III型12 例。骨质疏松按Singh指数分级: IV级2 例, III级8 例, II级12 例, I级1 例。结果 2 例患者术中并发股骨近端再骨折, 复位后采用钛捆绑带固定骨折。1 例患者术后3 d 发生急性左心衰, 给予扩血管、强心、利尿治疗后痊愈。3 例患者发生下肢深静脉血栓, 其中1 例因合并急性肺栓塞而死亡, 另2 例经抗凝、溶栓后痊愈。22 例患者获得随访, 随访时间12~64 个月, 平均31 个月。其中3 例患者死于内科系统疾病。末次随访时3 例患者小转子骨折仍未愈合, 其中1 例患者大转子向近端移位, 患侧外展肌无力, 跛行步态, 另16 例患者骨折均愈合;无一例患者发生假体脱位、感染及松动迹象。Harris评分从术前平均(33.11±6.58)分, 提高到末次随访时平均(87.12±5.05)分;其中优6 例, 良8 例, 可4 例, 差1 例, 优良率为74豫(14/19)。结论 非骨水泥型全涂层矩形柄人工髋关节置换治疗老年不稳定型股骨转子间骨折近期效果良好。

Uncemented hip arthroplasty for unstable intertrochanteric fractures in elderly patients

Objective To study the indication, surgical technique and clinical Results of the uncemented hip arthroplasty for unstable intertrochanteric fractures in elderly patients. Methods Twenty-three elderly patients with unstable interthochanteric fractures were treated with uncemented hip arthroplasty, including 6 males and 17 females with an average age of 77.6 years (range, 73-95 years). According to the Evans-Jensen classification, there were 2 cases of type IIA, 9 of type IIB, and 12 of type III. Osteoporosis was classified according to the Singh index, there were 2 cases of IV, 8 of III, 12 of II and 1 of I. Results All patients were followed up with an average of 31 months (range, 12-64 months). The average Harris score improved from 33.11?6.58 points preoperatively to 87.12?5.05 points at the time of the last follow-up. Radiologically, there were 16 cases of fixation by bone ingrowth; nonunion of lesser trochante fracture was noted in 3 cases; proximal displacement of greater trochante was found in one patient. Intraoperative proximal femoral fracture was encountered in two cases; deep venous thrombosis was found in three cases and one case died of pulmonary embolism. One case who experienced acute left ventricular failure recovered by medical treatment. There was no aseptic loosening, peri-prosthetic infections, dislocation or ectopic ossification. Conclusion The short-term Results of uncemented hip arthroplasty in elderly patients with unstable intertrochanteric fractures were satisfactory.