人工髋关节置换术治疗高龄股骨颈骨折

目的探讨人工双极股骨头置换和人工全髋关节置换术治疗高龄股骨颈骨折的疗效。方法对149例高龄(平均81.2岁)股骨颈骨折行人工髋关节置换手术,其中人工双极股骨头置换术101例,人工全髋关节置换术48例。结果 133例获随访8～62个月,平均38个月,人工双极股骨头置换组Harris评分>80分者95例,占94.1%;人工全髋关节置换组Harris评分>80分者46例,占95.8%。结论在积极有效治疗内科并发症、严格麻醉监护和规范手术操作的前提下,人工髋关节置换术是治疗高龄股骨颈骨折的首选方法。     

全髋关节置换术与人工股骨头置换术治疗高龄股骨颈骨折效果比较

目的分析比较全髋关节置换术(THR)与人工股骨头置换术(ATBA)治疗高龄股骨颈骨折的效果。方法选取2015-01—2017-03间息县人民医院收治的56例高龄股骨颈骨折患者。根据不同术式分为2组,各28例。观察组行THR,对照组行ATBA。对2组的治疗效果进行回顾性分析比较。结果观察组的手术时间及术中出血量均多于或长于对照组,差异有统计学意义(P0.05)。2组患者的术后下床活动时间及住院时间比较,差异无统计学意义(P0.05)。术后随访6个月,观察组并发症发生率、髋痛发生率、髋关节功能Harris评分及活动范围均优于对照组,差异有统计学意义(P0.05)。结论 THR治疗高龄股骨颈骨折,术后并发症少,远期效果优于ATBA。但ATBA操作简单,且手术时间、术中出血量和术后住院时间均优于THR。应根据患者的条件和术者的习惯个体化予以选择。     

全髋关节置换术与人工股骨头置换术治疗高龄股骨颈骨折的疗效比较

目的探讨全髋关节置换术与人工股骨头置换术治疗高龄股骨颈骨折的临床效果。方法按照随机数字表法将80例高龄股骨颈骨折患者分为全髋关节置换组(观察组)和人工股骨头置换组(对照组),各40例,比较2组疗效。结果 2组的总有效率、住院费用及住院时间比较,差异无统计学意义(P>0.05)。观察组术中出血量及手术时间均多于对照组,Harris评分高于对照组,差异均有统计学意义(P<0.05)。2组术后均有髋部疼痛,经对症治疗后痊愈,无其它严重并发症发生。结论高龄股骨颈骨折治疗中,全髋关节置换及人工股骨头置换均为安全有效的术式,需依据患者情况选择。预期生存时间长、身体条件较好、对术后功能要求高的患者可选择此术式治疗。     

全髋关节置换与人工股骨头置换术治疗高龄股骨颈骨折效果观察

目的观察全髋关节置换术(THR)与人工股骨头置换术(ATBA)治疗高龄股骨颈骨折的效果。方法随机将102例高龄股骨颈骨折患者分为2组,各51例。观察组实施THR,对照组行ATBA。比较2组疗效。结果观察组术中出血量、手术时间及住院时间均多于或长于对照组,差异均有统计学意义(P0.05)。随访6个月,观察组发生2例(3.92%)并发症,对照组为8例(15.69%),差异有统计学意义(P0.05)。末次随访,观察组患者的髋关节功能Harris评分优于对照组,差异有统计学意义(P0.05)。结论 ATBA治疗高龄股骨颈骨折,创伤小、操作简单;但THR术后并发症少,远期效果更好。     

高龄股骨颈骨折人工全髋和股骨头置换术的效果分析

目的分析高龄股骨颈骨折(FNF)人工全髋置换术(THR)和股骨头置换术(FHA)的疗效。方法选择2015-12-2018-12间西平县人民医院收治的65例高龄FNF患者,将行THR的34例作为观察组,行FHA的31例作为对照组。回顾性分析患者的临床资料。结果观察组的手术时间、术中出血量、术后住院时间,以及总治疗费用均长(多)于对照组,差异有统计学意义(P<0.05);但观察组患者的术后疼痛程度及完全负重时间、并发症发生率、髋关节功能均优于对照组,差异有统计学意义(P<0.05)。结论与THR比较,FHA治疗高龄FNF患者,创伤小、手术时间短、术中出血量少、住院时间短、总治疗费用少;但THR术后疼痛轻、并发症少,可早期负重活动,髋关节功能好。应依据患者的身体条件、经济状况,以及术者的经验,个体化予以选择。     

人工髋关节置换术治疗老年股骨颈骨折

目的探讨人工髋关节置换术治疗老年股骨颈骨折的临床疗效。方法对124例老年股骨颈骨折采用人工髋关节置换术治疗,随访观察术后治疗效果并根据Harris评分进行疗效评定。结果本组随访18～72个月,平均34个月。全髋关节置换术后假体松动翻修1例,人工股骨头置换术后髋部轻度酸痛22例。全髋关节置换组Harris评分优良率为94.3%,人工股骨头置换组Harris评分优良率为89.9%,差异无统计学意义(P>0.05)。结论老年股骨颈骨折行人工髋关节置换能早期进行功能锻炼及下床行走,减少并发症的发生,髋关节功能恢复好,可明显提高患者生活质量。     

高龄股骨颈骨折的人工关节置换术

对高龄股骨颈骨折患者,为了能达到尽早恢复活动,减少卧床时间和并发症,避免内固定失败后所承受的第二次手术打击,采用人工关节置换是较好的选择。笔者自1999年1月~2005年6月采用人工关节置换术治疗高龄股骨颈骨折33例,效果满意。1临床资料1·1一般资料本组33例,男12例,女21例;7     

高龄股骨颈骨折的人工关节置换术

对高龄股骨颈骨折患者，为了能达到尽早恢复活动，减少卧床时间和并发症，避免内固定失败后所承受的第二次手术打击，采用人工关节置换是较好的选择。笔者自1999年1月～2005年6月采用人工关节置换术治疗高龄股骨颈骨折33例，效果满意。     

人工髋关节置换术治疗高龄股骨颈骨折的临床研究

目的对比全髋关节置换(THA)与双动股骨头置换(BFHR)的临床应用结果,并分析高龄股骨颈骨折患者实施人工髋关节置换术的要点。方法高龄股骨颈骨折行髋关节置换72例,分为THA组42例,BFHR组30例。记录手术时间、术中术后出血量、开始下床活动的时间、Harris评分,以及术后并发症。结果随访11～25个月。BFHR组手术时间小于THA组(P<0.05);术中出血量BFHR组少(P<0.05);BFHR组的患者在术后主动直腿抬高角度大于THA组,术后开始下床活动时间明显缩短,术后1周髋关节Harris评分高,但术后6周、3个月、6个月的评分两组无显著性差异;BFHR组术后早期并发症发生率低,但远期髋关节疼痛的发生率高于THA组。结论高龄股骨颈骨折是行人工髋关节置换的适应证;双动股骨头置换术的术后近期恢复较好,但远期效果不及全髋关节置换术。     

全髋关节置换术治疗Hardasm型老年陈旧性股骨颈骨折

目的评价全髋关节置换术（THA）治疗HardasⅢ型老年陈旧性股骨颈骨折的疗效。方法对26例HardasⅢ型陈旧性股骨颈骨折采用髋关节后外侧入路行THA,均使用生物型假体。结果26例获平均3（0．5～6）年随访。末次随访时髋关节功能Harris评分：优18例,良6例,可2例,优良率92．3％。结论THA是治疗HardasⅢ型陈旧性股骨颈骨折的有效手段。术前充分骨牵引,术中松解挛缩组织、彻底止血,术后早期功能锻炼是手术成功的关键。     

骨水泥型人工髋关节置换术治疗老年不稳定股骨粗隆间骨折

目的探讨骨水泥型人工髋关节置换术治疗老年不稳定股骨粗隆间骨折的手术技术和疗效。方法采用骨水泥型柄行人工髋关节置换术治疗29例老年不稳定股骨粗隆间骨折,其中行全髋关节置换术6例,标准双极人工股骨头置换术23例。结果本组手术时间51～90min,平均78min;术中出血量300—600ml,平均410ml;其中19例术中输血,输血量200～800ml,平均320ml。随访期间死亡1例,其余28例术后随访5～30个月,平均18．6个月。术后1d患者可拄双拐下床活动。术后1个半月,24例患肢功能明显改善,行走能力基本恢复到伤前水平。未出现髋臼磨损及股骨假体松动、下沉等并发症。出现脑梗死1例,下肢深静脉血栓2例,异位骨化2例。髋关节功能按Harris评分标准评定：优6例,良18例,可4例,差1例。结论骨水泥型人工髋关节置换术治疗老年不稳定股骨粗隆间骨折有良好的近期疗效。     

应用Corail柄行全髋置换术治疗老年股骨颈骨折的中期随访

[目的]评价应用Corail羟基磷灰石全涂层股骨柄假体行全髋置换术治疗老年股骨颈骨折的中期疗效,并初步观察Corail假体在国人股骨髓腔中的下沉规律。[方法]对本院于2006年5月~2008年2月采用Corail假体行全髋置换术治疗的64例(64髋)老年股骨颈骨折患者病例资料进行回顾性分析。骨折Garden分型:Ⅲ型37例,Ⅳ型27例。所有患者于术前、术后行X线片,观察假体初始位置及下沉、应力遮挡性骨吸收、透亮区、骨溶解、异位骨化,按Engh标准评定假体的生物学固定,按Gruen法描述股骨柄分区,按Brooker标准对异位骨化进行分级。[结果]本组64例患者中,6例于术后3个月内失访,其余58例均获得5年以上(5.5~7.5)年随访,平均6.7年。术后切口均Ⅰ期愈合,无感染及血管、神经损伤并发症。其中,1例下肢深静脉血栓及1例术后髋关节脱位均经保守治疗后痊愈,3例出现BrookerⅠ级异位骨化,无特殊不适。随访末按Engh标准评定,58例假体均稳定,其中骨性固定53例(91.4%),纤维性固定5例(8.6%)。以Corail假体的无菌性松动和任何原因导致的翻修作为终点事件进行评估,随访末假体生存率为100%。患者髋关节功能从术前Harris评分平均47.5分改善至术后1年的平均89.1分及末次随访的平均90.4分,术后1年及末次随访时评分均优于术前,比较差异均有统计学意义(P0.05)。随访末患者SF-36评分结果仅生理职能、活力得分较参考值低外,其余各项得分与参考值比较差异均无统计学意义。[结论]采用Corail羟基磷灰石全涂层股骨柄假体行全髋置换术治疗老年股骨颈骨折能获得良好的假体稳定性,显著改善患者关节功能,并能获得较好的生存质量,且并发症较少,中期疗效满意。同时,Corail柄在国人股骨髓腔中的下沉主要发生于术后6个月内。     

Cementless hemiarthroplasty for femoral neck fractures in elderly patients

Objectives:

The use of cement is associated with increased morbidity and mortality rate in elderly patients, hence cementless hemiarthroplasty is suggested. We evaluated the results of cementless hemiarthroplasty for femoral neck fractures in elderly patients with high-risk clinical problems.

Materials and Methods:

Forty-eight patients (29 females, 19 males) with a mean age of 88 years (range: 78 to 102 years). having femoral neck fractures were treated with the use of cementless hemiarthroplasty. Porous-coated femoral stems were used in 30 patients (62%) and modular type femoral revision stems in 18 patients (38%). Bipolar femoral heads were used in all patients. Radiological follow-up after operation was done at the one, three, six months and annually.

Results:

The mean follow-up period was 4.2 years (range: 18 months to eight years). None of the patients died during hospitalization. Medical complications occurred in six patients (12%) within the follow-up period and four patients (8%) died within this period. Only two hips were converted to total hip arthroplasty due to acetabular erosion. Femoral revision was planned for one patient with a subsidence of > 3 mm. None of the patients had acetabular protrusion or heterotopic ossification. The mean Harris-hip score was 84 (range: 52 to 92). Dislocation occured in one patient (2%).

Conclusion:

Cementless hemiarthroplasty is a suitable method of treatment for femoral neck fractures in elderly patients with high-risk clinical problems especially of a cardiopulmonary nature. This method decreases the risk of hypotension and fat embolism associated with cemented hemiarthroplasty.     

人工髋关节置换术治疗高龄股骨颈骨折

目的探讨高龄股骨颈骨折患者理想的治疗方案。方法采用人工髋关节置换治疗70岁以上高龄股骨颈骨折患者37例。结果 37例均获随访,时间6～24个月。患者术后2～3周均恢复行走活动,无1例死亡。按髋关节功能Harris评分标准：优20例,良12例,可3例,差2例,优良率达86%。结论人工髋关节置换术治疗高龄股骨颈骨折患者,可早期下地活动,防止因长期卧床而出现的呼吸道及泌尿系感染等并发症;能早期恢复关节功能,提高生存质量。     

Total hip arthroplasty for acute femoral neck fractures using a cementless tapered femoral stem

The purpose of this study was to evaluate the osseointegration potential and implant-related complications of cementless total hip arthroplasty with a titanium alloy collarless, tapered, wedge-shaped femoral stem with a proximal circumferential plasma-spray coating in patients with acute hip fractures. The cohort consists of 85 patients with a mean age of 78.1 years. The mean duration of follow-up was 3.8 years. Total hip arthroplasty conferred significant improvement in function for all patients. All femoral components were stable with evidence of bone ingrowth (84 hips) or fibrous fixation (1 hip). Mild thigh pain was present in 3 patients. The complications included dislocation (3 cases), intraoperative femoral fracture (2 cases), and periprosthetic femoral fracture in the postoperative period (1 case). There was one reoperation for revision of the femoral component in the patient with a periprosthetic fracture. There were 25 (29%) deaths. Cementless total hip arthroplasty using a tapered proximally coated femoral stem is a viable option for the treatment of a displaced hip fracture and preexistent arthritis.     

人工髋关节置换治疗高龄股骨颈骨折

目的探讨高龄股骨颈骨折人工髋关节置换的疗效。方法采用髋关节后外侧人路对58例（58髋）高龄股骨颈骨折患者行人工髋关节置换。结果经过3～19（8．5±0．5）个月随访,58例术后2～3周均恢复行走活动,无1例死亡。按髋关节功能Harris评分标准：优21例（21髋）,良31例（31髋）,可4例（4髋）,差2例（2髋）,优良率89．7％。结论人工股骨头或全髋关节置换术是治疗高龄股骨颈骨折的有效方法,可早期活动,恢复关节功能,提高生存质量。     

Bipolar versus fixed-head hip arthroplasty for femoral neck fractures in elderly patients

Between 2002 and 2007, fifty elderly patients with displaced femoral neck fractures were treated with hip replacement at Emergency Hospital, Mansoura University. Patients were randomly selected, 25 patients had either cemented or cementless bipolar prosthesis, and another 25 patients had either cemented or cementless fixed-head prosthesis. There were 34 women and 16 men with an average age of 63.5 years (range between 55 and 72 years). All patients were followed up both clinically and radiologically for an average 4.4 years (range between 2 and 6 years). At the final follow-up, the average Harris hip score among the bipolar group was 92 points (range between 72 and 97 points), while the fixed-head group was 84 points (range between 65 and 95 points). Radiologically, joint space narrowing more than 2 mm was found in only 8% (2 patients) among the bipolar group, and in 28% (7 patients) of the fixed-head group. Through the follow-up period, total hip replacement was needed in two cases of the bipolar group and seven cases of the fixed-head group. Bipolar hemiarthroplasty offered a better range of movement with less pain and more stability than the fixed-head hemiarthroplasty in elderly patients with displaced femoral neck fractures.     

人工全髋关节置换术治疗老年股骨颈骨折

目的探讨人工全髋关节置换术治疗老年股骨颈骨折的临床疗效。方法对52例应用人工全髋关节置换术治疗老年股骨颈骨折患者临床资料进行回顾性分析,并对骨水泥固定16例与未用骨水泥固定18例的临床疗效进行比较。结果随访时间1-10年,平均5年6个月。根据Harris髋关节评分标准,骨水泥组疗效：优11例,良8例,尚可4例,差2例;非骨水泥组疗效：优11例,良10例,尚可5例,差1例。结论人工全髋关节置换术是老年股骨颈骨折的理想治疗方法．府用骨水泥固定与非骨水泥方法．两者疗效并无显著善异．     

大头金对金全髋关节置换治疗老年人股骨颈骨折近期疗效

目的 探讨大头金对金全髋关节置换术治疗老年人股骨颈骨折的近期疗效.方法 55例老年股骨颈骨折患者(55髋)中,26髋采用大头金对金全髋关节置换(观察组),29髋采用常规小头金属对聚乙烯全髋关节置换(对照组),比较两组的临床疗效,对并发症进行分析.结果 55例门诊随访12~23(18.3±5.4)个月.术后对照组发生脱位1例2次;观察组无脱位发生.观察组术后6、12周的髋关节活动范围和术后12个月的Harris评分优秀率均优于对照组,差异有统计学意义(P<0.05).结论 大头金对金全髋关节置换术治疗老年股骨颈骨折,具有术后脱位率低、关节活动范围大等优点,近期临床疗效满意.     

骨水泥型人工股骨头置换治疗高龄股骨颈骨折

目的探讨骨水泥型人工股骨头置换治疗高龄股骨颈骨折的近期疗效。方法对30例高龄股骨颈骨折患者采用骨水泥型人工股骨头置换治疗。根据Harris评分法评估临床效果。结果 30例均获得随访12~24个月。患者髋关节功能均恢复良好,未发现感染、髋内翻、假体松动下沉、关节脱位者。髋关节功能根据Harris评分,优17例,良9例,中4例,优良率86.67%。结论应用骨水泥型人工股骨头置换治疗高龄股骨颈骨折患者手术风险小、费用低、并发症少,术后可早期下床活动,提高了生活质量,疗效可靠。