双极股骨头置换术治疗老年不稳定股骨粗隆间骨折的预后疗效分析

目的探讨双极股骨头半髋置换治疗老年不稳定粗隆间骨折的预后并分析其影响因素。方法回顾性分析对2005年3月至2009年10月收治的双极股骨头半髋置换治疗老年不稳定粗隆间骨折的86例患者临床资料，男32例，女54例；年龄71～98岁，平均83．4岁。Evens-JensenⅢ型50例，Ⅳ型36例。57例患者伴有严重骨质疏松。受伤至入院时间1h-8d，平均1．5d，人院至手术时间3-9d，平均4．2d。骨水泥型股骨柄假体置换65例，生物型股骨柄假体置换21例；术中重建股骨距52例，未重建股骨距34例。结果最终68例患者均获得随访，随访时间为12～60个月，平均38个月。单因素与多因素分析均显示骨折分型及是否重建股骨距对股骨柄假体稳定性有显著影响（P〈0．05）。髋关节Harris评分优良率82．4％，单因素分析显示骨折分型及是否重建股骨距对术后髋关节功能恢复有显著影响（P〈0．05），多因素分析显示是否重建股骨距是影响术后髋关节功能恢复的主要因素。25例患者死亡，死亡率为32．1％，其中死于心肺疾患占56．O％。单因素与多因素均分析显示患者性别、年龄及是否重建股骨距对术后死亡率有显著影响（P〈0．05）。结论老年股骨粗隆间骨折可以通过双极人工股骨头半髋置换治疗获得良好疗效。骨折分型及术中是否重建股骨距是影响术后假体稳定性和髋关节功能的主要因素，高龄及合并心肺疾患患者死亡风险更大。

Prognosis analysis of bipolar hemiarthroplasty in treating unstable intertrochanteric hip fractures of elderly patients

Objective To discuss the prognosis of the unstable intertrochanteric hip fractures treated by bipolar hemiarthroplasty and to analyze the possible influencing factors in the elderly. Methods The clinical outcomes of 86 elderly patients with the unstable intertrochanteric hip fractures were retrospectively analyzed. All the patients underwent bipolar hemiarthroplasty from March 2005 to October 2009. There were 32 males and 54 females with a mean age of 83.4 years （ range, 71 to 98）. The fractures were classified according to the Evens-Jensen classification system： 50 cases of type Ⅲ, 36 cases of type Ⅳ. 57 cases combined with severe osteoporosis. The time from injury to admission was between one hour and eight days, and the average time was 1.5 day. The time from admission to operation was between three days and nine days, and the agerage time was 4. 2 days. 65 cases had cemented bipolar hemiarthroplasty, 21 cases had uncemented bipolar hemiarthroplasty. 52 cases received reconstruction of the femoral calcar, while the other 34 cases did not. Results 68 patients were followed up for 12 - 60 months （38 months in average）. The single- and multiple-factor analyses showed that the fracture type, and the reconstruction of the femoral calcar significantly related to the femoral component stability （ P 〈 0. 05）. The hip function was graded by the Harris system and the choiceness rate was 82.4%. The single- factor analysis showed that the fracture type and the reconstruction of the femoral calcar significantlyaffecting the hip function recovery （ P 〈0. 05 ）. The multiple-factor analysis showed that the reconstruction of the femoral calcar was the major factor in the hip function recovery. 25 patients died and the mortality rate was 32.1%. The causes of death mainly were cardiorespiratory disturbances （ 56.0% ）. The single- and multiple-factor analyses showed that gender, age and the reconstruction of the femoral calcar were significantly correlated with the mortality （ P 〈 0. 05 ）. Conclusion The bipolar hemiarthroplasty in treating unstable intertrochanteric hip fractures of the elderly patients can achieve good outcomes. The fracture type and the reconstruction of the femoral calcar are the factors influencing factors for the components stability and the hip function recovery. The elderly patients with cardiorespiratory disturbance have a higher death risk.