人工关节置换术治疗80岁以上老年股骨颈骨折68例

目的 探讨80岁以上老年股骨颈骨折人工关节置换的疗效及治疗风险.方法 我院2005年1月-2011年12月共对68例超过80岁的股骨颈骨折患者行人工关节置换术.57例行人工股骨头置换术,11例行人工全髋关节置换术.结果 68例手术均顺利,术中出血80～600 ml,平均230 ml,术中无死亡病例.住院期间死亡1例,出院后1天死亡1例,死亡原因考虑急性肺栓塞.早期发生肌间隙出血致患肢肿胀12例,肺部感染8例,急性左心衰5例,输血反应4例,过敏反应3例,切口液化、渗液不愈合1例,经积极治疗均痊愈或好转.66例术后随访4个月～6年.按Harris髋关节评分评定疗效:优46例,良12例,可8例,差2例,优良率为85.3%.发生脱位2例,髋臼磨损6例,对侧髋部骨折6例,同侧股骨骨折1例.结论 人工关节置换疗效确切,是治疗高龄股骨颈骨折较理想的手术方法,但是相对于80岁以上的老年患者创伤较大,需合理选择术式,谨慎处理,做好围术期各项工作,方能保证治疗安全.

Clinical Analysis of 68 Prosthetic Replacement for Joint in Treatment of Elderly Patients (over 80 Years) with Femoral Neck Fracture

Objective To explore the effect and the risk of treatment of patients over 80 Years with senile femoral neck fracture by prosthetic replacement for joint. Methods 68 elderly patients （ over 80 years） with femoral neck fracture during January 2005 and December 2011 were treated with prosthetic replacement for joint. 57 patients were given artificial femoral head replacement and 11 patients were given THR. Results 68 patients＇operations were all successful . Intraoperative blooding was 80-600 ml, the average was 230 ml and no deaths occurred during surgery. 1 patient died during the period of hospitalization and 1 patient died with possible acute pulmonary embolism after one day discharged from hospital. 12 patients with early development intramuscular diastematic bleeding were swelling and distension in the affected limb, 8 with pulmonary infection, 5 with acute left heart failure, 4 with blood transfusion reactions, 3 with anaphylaxis and 1 with colliquation, exudate and disunion in incision, and patients were all recovered or better after active treatment. 66 patients were followed-up for 4 months to 6 years, and clinical efficacy were evaluated by Harris hip joint score system： excellent in 46 patients, good in 12, common in 8 and poor in 2, excellent rate was 85.3%. There were 2 patients with dislocation, 6 with acetabular abrasion, 6 with contralateral hip fracture and 1 with the ipsilateral femoral fractures. Conclusion The artificial joint replacement is an effective treatment for elderly patients with femoral neck fracture, but the wound is relatively large for patients over 80 years old. Reasonable treatment should be taken with due diligence and everything done for the safety of therapy.