人工髋关节置换治疗内固定失败和高龄严重股骨粗隆间骨折

目的：探讨人工髋关节置换治疗高龄严重股骨粗隆问骨折和内固定失败病例疗效，初步总结分析此类手术的适应证及方法特点。方法：自1997年6月～2002年12月，收治股骨粗隆间骨折内固定失效8例，高龄严重粉碎移位股骨粗隆间新鲜骨折6例。采用全髋关节置换9例，双极人工股骨头置换5例，1例术中股骨近端骨折，加环抱器固定。结果：随访3个月～5年半，2例出现关节周围异位骨化，没出现感染、术后骨折、脱位、假体松动及血管栓塞等并发症，Harris评分，术前平均42分(24～56分)，术后平均86分(65～99分)。结论：股骨粗隆间骨折内固定失败及部分高龄严重移位股骨粗隆间骨折，人工髋关节置换是一种直接有效的治疗方法。

Treatment of Intertrochanteric Fractures after Failed Internal Fixation and Serious Fresh Intertrochanteric Fractures with Artificial Hip Replacement

Objective:To discuss the effect of treating intertrochanteric fractures after failed internal fixation and serious fresh intertrochanteric fractures with artificial hip replacement,and to summarize and analyze elementarily indications and characteristics of those operations.Methods:From June 1997 to December 2002,8 cases intertrochanteric fractures after failed internal fixation and 6 cases serious fresh intertrochanteric fractures were treated.9 cases of those were treated with total hip arthroplasty and 5 cases of those were treated with bipolar hemiarthroplasties.In operation,1 case with fracture at proximal femur were found and the fracture at proximal femur was fixed with Ogden plate.Results:The following up period lasted from 3 months to 5 years and an half.2 cases with heterotopic ossification were found;No case had infections,fractures,dislocations,loosening of artificial joints and deep vein thrombosis.To evaluate in according to Harris standard:average score of preoperation was 42(24-56),and postoperative score was 86(65-99).Conclusion:To treat intertrochanteric fractures after internal fixation failed and less serious fresh intertrochanteric fractures with artificial hip replacement was a direct and effective way.