股骨柄假体人工半髋关节置换治疗高龄股骨转子间骨折

目的总结加长的中远端稳定的生物型股骨柄假体人工半髋关节置换治疗高龄股骨转子间骨折的临床疗效。 方法采用随机数字表法将2009年1月到2015年12月绵阳市骨科医院94例75～95岁高龄不稳定型股骨转子间骨折患者分为骨水泥组和生物组各47例，纳入标准为患者外力创伤后经诊断为不稳定型股骨转子间骨折，无手术绝对禁忌证。骨水泥组给予骨水泥假体人工半髋关节置换，生物组给予加长生物型假体人工半髋关节置换。用SPSS 23.0软件包用t检验比较2组患者手术时间、术中出血量、围术期总失血量、术后并发症发生率、术后初次下地煅炼时间、术后住院时间、术后3月、6月、12月Harris评分，用χ²检验2组优良率。 结果生物组手术时间、术中出血量低于骨水泥组(手术时间：t ＝3.733，术中出血量：t ＝2.207，均为P<0.05)，2组围手术期失血量、初次下地煅炼时间和术后住院时间相比较差异均无统计学意义(P>0.05)。生物组和骨水泥组切口感染发生率相比较差异均无统计学意义(P>0.05)，生物组深静脉血栓和心肺事件发生率与骨水泥组相比较均显著降低(深静脉血栓：χ² ＝4.642，心肺事件：χ² ＝6.409，均为P<0.05)。2组术后3月、术后6月、术后12月Harris评分相比较差异均无统计学意义(P>0.05)。2组术后3月、6月、12个月手术效果相比较差异无统计学意义(P>0.05)。 结论加长的远端稳定的生物型股骨柄假体人工半髋关节置换治疗高龄股骨转子间骨折可获得与骨水泥型假体一样的临床效果，且可减少创伤和降低术后并发症发生率，具有临床推广价值。

Artificial hemiarthroplasty of femoral stem prosthesis in treatment of femoral intertrochanteric fracture in elderly patients

ObjectiveTo investigate the clinical effect of lengthened distal stable biological femoral stem prosthesis hemiarthroplasty in the treatment of elderly patients with intertrochanteric fractures. MethodsA total of 94 elderly patients (75~95 year old) with unstable intertrochanteric fractures in Mianyang Orthopaedic Hospital during Jan. 2009 to Dec. 2015 were divided into the cement group and the biological group by random number table, 47 cases in each group. Inclusion creteria were unstable intertrochanteric fracture after trauma, and no contraindication for surgery. The cement group was treated by hemiarthroplasty with bone cement prosthesis, and the biological group was treated with lengthened biological prosthesis. the operation time, intraoperative blood loss, total perioperative blood loss, postoperative complications, first postoperative calcification time, postoperative hospital stay, and postoperative Harris scores were compared between the two groups by t test using SPSS 23.0 software. The excellent rates were compared by chi-square test. ResultsThe operation time, intraoperative blood loss of biological group were lower than those of bone cement group (time: t =3.733, blood loss: t =2.207, both P<0.05), and there was no significant difference between the two groups in perioperative blood loss, first ambulant time and postoperative hospital stay (P>0.05). There was no significant difference between the two groups in the rate of operative site infection and periprosthetic fracture (P>0.05). The incidence of deep venous thrombosis (DVT) and cardiopulmonary events (CPE) in the biological group was significantly lower than that in the cement group (DVT: χ² =4.642, CPE: χ² =6.409, both P<0.05). There was no significant difference between the two groups in Harris scores at three months, six months and 12 months after the operation(P >0.05). There was no significant difference between the two groups in excellent rate at 12 months after the operation (P >0.05). ConclusionThe long distal stable biological femoral stem prosthesis for hemiarthroplasty in treatment of the elderly patients with intertrochanteric fractures can achieve the same clinical effect as bone cement prosthesis, and can reduce trauma and the incidence of postoperative complications.