加长柄人工双极股骨头置换治疗高龄股骨粗隆间粉碎性骨折

目的 探讨人工股骨头置换治疗老年股骨粗隆间粉碎性骨折的疗效。方法 2004年2月-2006年3月，应用加长柄骨水泥型双极半髋置换治疗高龄股骨粗隆间粉碎性骨折89例。男34例，女55例；年龄70～92岁，平均82．6岁。新鲜骨折76例，陈旧性骨折13例。骨折按改良Evans．Jensen分型：Ⅲ型32例，Ⅳ型57例。骨质疏松Singh指数分级：Ⅳ级24例，Ⅲ级46例，Ⅱ级19例。损伤至手术时间4～36d，平均65d。结果 手术时间50～70mm，平均62min；出血量100～250mL，平均150mL。术后88例切口Ⅰ期愈合，1例术后切口深部感染，经二次手术翻修后愈合。住院时间16～25d，平均18．6d。术后钢丝断裂及骨质切割松动失效各1例，临床无不适症状未予处理。2例术后第2～3天出现精神症状、术后1周内泌尿系统和呼吸系统感染各1例，经对症处理后痊愈。85例获随访14～39个月，平均265个月。髋关节功能按Hams评分：优16例，良56例，中12例，差1例，优良率84．7％。结论 加长柄人工双极股骨头置换是治疗高龄股骨粗隆间粉碎性骨折的一种有效方法，但须严格掌握手术适应证和术中操作技巧。

TREATMENT OF INTERTROCHANTERIC COMMINUTED FRACTURE IN AGED PATIENTS BY REPLACEMENT OF ARTIFICIAL LONG-STEM BIPOLAR FEMORAL HEAD

OBJECTIVE: To discuss the clinical effect of hip arthroplasty for the treatment of intertrochanteric comminuted fracture in aged patients. METHODS: From February 2004 to March 2006, 89 cases with intertrochanteric comminuted fractures were treated by replacement of artificial long-stem bipolar hip hemiarthroplasty with bone cement, including 34 males and 55 females, with the average age of 82.6 years (ranging from 70 years to 92 years). There were fresh fractures in 76 cases and old fractures in 13 cases. According to improving-classification of Evans-Jensen, there were 32 cases with type III fracture and 57 with type IV. Osteoporosis was graded by Singh-index, and there were 24 cases with level IV, 46 with level III and 19 with level II. The operation was delayed from 4 days to 36 days (6.5 days on average) after the injury. RESULTS: The surgery time lasted from 50 minutes to 70 minutes (62 minutes on average). Bleeding volume was from 100 mL to 250 mL (150 mL on average). The time in hospital was from 16 days to 25 days (18.6 days on average). All incision primarily healed except 1 case which delayed union by revision with infection. Steel wire rupture occurred in 1 case, invalidation in 1 case. They were not treated because there were no uncomfortable symptoms. The consciousness disability happened in 2 cases 2 to 3 days after the operation, 2 case with the infection for the system of urine and breath 1 week after operation, were healed through the treatment. Eighty-five cases were followed up for 14 months to 39 months (26.5 months on average). The function of the hip was graded by the system of Harris and the choiceness rate was 84.7% (excellent in 16 cases, good in 56 cases, fair in 12 cases and poor in 1 case). CONCLUSION: The treatment of intertrochanteric comminuted fracture in the aged patients by replacement of long-stem bipolar femoral head prosthesis is effective, but indications and techniques of the operation must be paid much attention to.