骨水泥半髋关节置换治疗老年不稳定性股骨转子间骨折

目的 探讨应用骨水泥半髋关节置换术治疗老年不稳定性股骨转子间骨折的可行性和近期疗效.方法 回顾性分析2009年10月至2012年3月应用骨水泥半髋关节置换术治疗高龄不稳定性股骨转子间骨折21例,其中男9例,女12例；年龄76～91岁,平均81.6岁.骨折分类按Evans-Jensen分型,Ⅱ型4例,Ⅲ型13例,Ⅳ型4例.结果 手术时间40～60 min,平均48 min,出血量260～500mL,平均380mL,术后全部患者切口均一期愈合,住院时间21～35 d,平均28.6d.2例患者术后发生肺部感染,经过抗感染、化痰、雾化吸入等治疗后痊愈.术后全部患者随访12～18个月,平均15.8个月,术后2周患者可借助双拐下床活动,术后2个月,18例患者行走能力基本恢复至伤前水平,生活能自理.末次随访时Harris评分为50～90分,其中优5例,良13例,可3例,优良率85.7％.无一例出现髋臼磨损、假体下沉、感染等相关手术并发症.结论 应用骨水泥半髋关节术治疗高龄不稳定性转子间骨折是一种有效的方法,术后可早期下床活动,提高生活质量.

Treatment of Unstable Intertrochanteric Fractures by Hemiarthroplasty Using Cemented Implant in Elderly Patients

Objective To discuss the clinical effects of cemented hemiarthroplasty for the treatment of unstable intertrochanteric fractures in elderly patients. Methods From October 2009 to March 2012, 21 cases with in- tertrochanteric comminuted fractures were treated with cemented hemiarthroplasty,including 9 males and 12 females, with an average age of 81. 6 years （range 76~ 91 years）. According to the Evans-Jensen classification,there were 4 cases of type Ⅱ ,13 cases of type Ⅲ and 4 cases of type Ⅳ. Results The surgery lasted 40~60 rain （average,48 rain ）. The blood loss was 260~500 mL （average 380 mL）. The hospital stay was 21~ 35 d （average, 28. 6 d）. Two cases who experienced with the infection of respiratory system after operation,recovered through routine treatment. All cases were followed up for 12 to 18 months （average, 15.8 months）. The patients were encouraged to walk with aid about 2 weeks postoperatively. Two months after operation,the walking ability were almost recovered to pre-in- jury level in 18 cases. According to the Harris score （range 50~ 90）, 5 cases were classified as excellent, 13 cases as good and 3 cases as fair. The overall rate of excellent or good results was 85.7%. The acetabular wear,the prosthetic loosening and infection were not found. Conclusion Cemented hemiarthroplasty prosthesis is reliable option for un- stable intertroehanteric fractures in the aged patients. The quality life of elderly patients can be improved owing to early exercise after surgery.