高龄股骨粗隆间骨折髋关节置换手术策略的探讨

目的探讨高龄股骨粗隆间骨折患者行髋关节置换术的手术技巧及临床疗效。方法 2005年7月至2008年12月,选择性应用半髋关节置换治疗高龄股骨粗隆间骨折患者26例,其中男7例,女19例;年龄80-98岁,平均83岁。26例均为轻微外伤造成闭合性骨折。按Evans分型,b型8例,c型13例,d型5例。右侧9例,左侧17例。26例患者中25例合并有不同程度的高血压、糖尿病、冠心病、心功能不全等内科疾病情况,有3例一侧髋部骨折行钢板或关节置换术后又发生另一侧粗隆间骨折。26例患者均行骨水泥型双动股骨头置换。结果所有患者平均随访18个月（6-36个月）,平均手术时间87 min（60-120 min）,术中出血量350 mL（100-700 mL）,术后平均下地活动时间8.5 d（4-10 d）。术后发生严重并发症患者3例,均进行积极的专科及综合治疗,1例术后因心肌梗塞抢救无效3 d内死亡;1例术后发生弥漫性血管内凝血,经输新鲜血浆、红细胞等其他治疗,恢复良好;1例术后发生大面积脑梗塞,转神经内科治疗,7个月时随访患侧上、下肢肌力级。5例术后发生一过性精神障碍,对症治疗后均1周左右症状恢复正常。1年后随访时1例因肺部感染死亡,1例因心力衰竭死亡。所有切口均一期愈合,无切口感染,无髋关节脱位。术后3个月时参照Charnley髋关节评分,优10例,良11例,可3例,差1例,优良率84%。结论高龄股骨粗隆间骨折患者选择性行人工关节置换是内固定方法的有益补充,手术注意正确放置假体,避免肢体不等长,小心扩髓,避免术中骨折,简单固定大、小粗隆骨折,尽量缩短手术时间,减少手术创伤。

Surgical Strategy Using Hemiarthroplasty for Unstable Intertrochanteric Fracture in Elderly Patients

Objective To evaluate the surgical strategy and effectiveness of hemiarthroplasty for unstable intertrochanteric fracture in patients over 80 years old.Methods Between 2005 and 2008,26 elderly patients with an Evans type Ⅰ unstable intertrochanteric fracture of femur underwent hip hemiarthroplasty using bone cement.There were 7 males and 19 females.The mean age was 83 years（range 80 to 97 yeas）.25 patients had more than one kind of concomitant diseases.They could walk with or without canes,and take care of themselves partly before the fractures.Special surgical strategy should be paid during the operation.The mean followed-up time was 18 months（range 6～36 months）.The Charnley hip score was used to analyze the clinical results.Results All operations were successful.The mean operative time was 87 minutes（60～120 minutes）,the intraoperative blood loss was 350 mL（100～700 mL）.25 cases ambulated by protected within 10 days after operation.The complications included：one patient died at the post-operation three days;five patients underwent psychological disorder after operation,one had DIC,and were gradually recovered after appropriate treatment.Large area cerebral embolism accrued in one patient and has perpetual paralysis of the left side limbs.two patients died of other diseases in one year;The Charnley hip score at three months after operation was：excellent 10 cases,good 11 cases,average 3 cases and inferior 1 case.Conclusion Hemiarthroplasty can be an alternative treatment for unstable intertrochanteric fractures in elderly patients so as to achieve earlier mobilization,reduce mortality,and improve the patients′ quality of life.