半髋置换在高龄不稳定型股骨转子间骨折治疗中的价值

目的探讨半髋置换在高龄不稳定型股骨转子间骨折中的疗效及应用价值。方法不稳定型股骨转子间骨折患者75例,男性30例,女性45例,年龄78～95岁,平均83岁,骨折按Evans-Jensen分型,ⅡA型21例,ⅡB型24例,Ⅲ型30例。采用钢丝环扎固定大、小转子,重建股骨距,均使用骨水泥型假体。从手术时间、术中出血量、术中及术后并发症、输血量、负重时间、髋关节功能恢复率等方面评价治疗效果。结果 73例完成随访,随访时间6～56个月,平均(37±6.3)个月;手术时间65～95 min,平均(82±5.7)min;术中出血量200～450 ml,平均(355±8.9)ml;35例输血,平均输血量(185±4.0)ml;术后7 d内下地活动70例,7～14 d下地5例,平均(5.5±0.6)d;3例深静脉栓塞;20例精神障碍;住院期间无死亡病例;出院后死亡2例;髋关节功能优良率89.3%。结论半髋置换是治疗高龄不稳定型股骨转子间骨折的有效方法,具有负重时间早、功能恢复满意等优点,并发症发生率无明显升高,可明显改善高龄患者的生活质量。

The value of hemiarthroplasty for the treatment of unstable intertrochanteric fracture in elderly patients

Objective To investigate the clinical results and the value of hemiarthroplasty for the treatment of unstable intertrochanteric fracture in elderly patients. Methods We retrospectively reviewed 75 patients （ male 30 and female 45 ） who were treated for unstable intertro- chanteric fractures with hemiprosthesis arthoroplasty in our hospital between January 2007 and January 2012. The average age was 83 years old （ range from 78 to 95 years old）. There were 21 cases in type 11 A, 24 cases in type I1 B and 30 eases in type m according to the Evans - Jensen classification of intertrochanteric fractures. The greater and lesser trochanters were fixed with a novel cerclage. Cemented bipolar hemiarthroplasty was used in all of the patients. The data were collected for statistical analysis on the following aspects： operating time, blood loss, intraoperative complications, postoperative complications, blood transfusion, time to weight - beating, restored rate of hip function. Results All of the patients had adequate follow - up except 2 patients. The mean of follow - up time was 37 months （6 ~56 months）. The duration of the operation was 65 to 95 minutes with an average of （ 82 ＋ 5.7 ） minutes. Intraoperative blood loss was 200 - 450 ml with an average of （355 ＋ 8.9 ） ml. Blood was transfused in 35 patients and the average of transfusion was （ 185 ＋ 4.0） ml. The patients got up to weight - bearing within 7 days in 70 cases, 7 14 days in 5 cases and the average of time to weight - bearing was （5.5 ＋ 0.6） days. Deep phlebitis was occurred in 3 patients. 20 patients showed psychological disorders. 2 patients died after the hospitalization. Good to excellent rate of hip function was 89.3%. Conclusion Hemiprosthesis arthroplasty is an effective way of treating unstable intertrochanteric fracture in elderly patients. The restored rate and time of hip function were satisfactory. It can improve the patient living quality without complication increase.