人工股骨头置换治疗90岁以上患者髋部骨折

目的]报告人工股骨头置换治疗90岁以上患者髋部骨折的疗效。方法]本组23例（24髋），男7例，女16例：年龄90～100岁，平均94岁。骨折分类：股骨颈骨折10例，按Garden分型，Ⅲ型6例，Ⅳ型4例；股骨粗隆问骨折13例（1例为双侧），按Evans分型，ⅢA型6例，ⅢB型6例，Ⅳ型1例。除2例在室外被碰伤外，其余骨折均发生在室内。患者入院后暂用皮牵引制动患肢，然后抓紧时间进行各项必要的术前检查，了解患者的健康情况。争取在短时间内请有关科室联合会诊，对患者的全身情况评估，论证能否耐受手术。本组患者在骨折前均并存各种不同程度的内科疾病，但经过对症处理相对稳定，大部分都能生活自理，经过评估后认为无绝对手术禁忌证。手术均用气管插管全麻，术中心电监护仪监护。取侧卧位，髋后外侧切口，股骨颈骨折的手术操作与其他年龄段患者操作相同。股骨粗隆间骨折，需要将骨折分离的股骨大、小粗隆重新复位，用钢丝捆绑固定，股骨距部位的骨缺损用骨水泥充填、重塑。股骨粗隆问骨折患者术中适当输血，本组8例术中输血200～800ml，平均400ml：关节腔内置负压引流管，48～72h后拔除。结果]23例均顺利通过手术，术后下床时间2～7d，平均4d，住院时间15～28d，平均21d。并发症：6例术后出现一过性精神障碍，经过治疗逐渐恢复；1例出现患肢轻度深静脉炎，对症处理后未影响治疗效果；1例95岁女性患者ⅢB型股骨粗隆问骨折，术后3周死于多脏器功能衰竭。16例（9例股骨粗隆间骨折，7例股骨颈骨折）有随诊结果，随访5～36个月，平均8个月。10例（6例股骨粗隆问骨折，4例股骨颈骨折）基本达到骨折前的状况，5例（2例粗隆间骨折，3例股骨颈骨折）生活部分自理，1例股骨粗隆间骨折患者术后6个月死于其他疾病。结论]人工股骨头置换治疗90岁以上患者髋部骨折，疗效满意，可早下床活动，减少并发症，降低死亡率，改善生活质量，减轻家庭生活护理负担。

Cemented hemiarthroplasty for hip fractures in the elderly patients over 90 years old

Objective]To review the effect of 23 cemented hemiarthroplasties in elderly patients over 90 years old with hip fractures.Method]There were 23 eases (24 hips) in this group including 7 males and 16 females, aged 90 ~ 100 years with an average of 94 years. There were 6 eases of type III and 4 eases of type IV of femoral neck fractures according to the classification of Garden; and 6 eases of type III A, 6 eases of type III B and 1 ease of type IV of intertrochanteric fractures according to the classification of Evans. After patients had admitted to hospital, the affected extremity was maintained with skin traction, medical disorders were treated properly, and no absolute contra-indication was found after thorough examination. Femoral hemiarthroplasty was performed after the patient' s general condition reached stable. All patients were generally anesthetized and monitored with cardio-electrography. The separated greater and lesser trochanteric fragments were reduced and fixed with steel wires. Bone defect in the femoral calcar was crammed with bone cement. Blood was transfused in 8 patients with intertrochanteric fracture between 200 ~ 800 ml with an average of 400 ml during the operation. Suction drainage was removed 48 ~ 72 hours after the operation.Result]All operations were successful, and the patients got out of the bed after 2~7 days with an average of 4 days. The period of hospitalization was between 15 ~ 28 days with an average of 21 days. Complications were as following: psychological disorders were found in 6 eases after the operation, but gradually recovered after appropriate treatments; 1 patient got deep phlebitis, but the affected extremity had not been harmed after proper treatment, 1 95 year-old patient with type III B intertrochanteric fracture died of multiple organs failure 3 weeks after the operation. Sixteen patients, of which 9 were with intertrochanteric fractures, and 7 with femoral neck fractures, were followed up for 5 to 36 months with an average of 8 month. According to the result, daily activities resumed completely in 10 cases( 6 intertrochanteric fractures and 4 femoral neck fractures) , daily activities resumed partly in 5 cases (2 intertrochamteric fractures and 3 femoral neck fractures ) , 1 patient with intertrochanteric fracture die of other diseases 6 months after the operation.Conclusion]It' s an effective method to treat hip fractures in patients over 90 years with artificial femoral head reduction. The result is satisfactory and it has advantaged such as less complications, less mortality rate, better life quality, and the burden of patient' family could been reduced.