80岁以上股骨颈骨折患者人工股骨头置换手术后生活质量评价

目的 分析80岁以上高龄患者股骨颈骨折人工股骨头置换手术后1年的生活质量,为今后治疗提供临床经验。方法 对1995年2月～2001年2月北京医院骨科进行的52例高龄股骨颈骨折患者行人工股骨头置换术作回顾性分析。患者年龄80～95岁,平均年龄84．2岁,其中男性28例,女性24例,骨折均为GardenⅢ、Ⅳ型,均行国产单极型人工股骨头置换术,大部分患者术前有内科合并症。随访术后1年时的症状、日常活动能力,采用髋关节Harris评分(不包括关节活动范围和髋关节畸形情况)及不同时期髋关节正、侧位X线片进行评估。结果 无任何髋部疼痛46例(88．46％),隐痛或轻微疼痛6例(11．54％)。能独立行走24例(46．2％);需要用辅助器行走者24例(46．2％),卧床或坐轮椅4例(7．7％)。神经内科合并症术后多有复发、加重,一般内科合并症术后多较平稳。38例随访时有术后X线片,时间从术后3个月至术后5年6个月,平均54．2个月。仅有3位假体柄周围出现硬化线,无股骨头中心性脱位及骨性关节炎改变。结论 没有明显手术禁忌证的高龄股骨颈骨折患者可以积极采取手术治疗,以期尽快恢复老年人的活动功能,减少卧床引起的并发症,提高生活质量。

Evaluation of the postoperative quality of life in the elderly over 80 years old who underwent hip hemiarthroplasty for femoral neck fracture

OBJECTIVE: To evaluate the postoperative quality of life of aged patients (> 80 years old) who underwent hip hemiarthroplasty for femoral neck fracture one year ago. METHODS: From February 1995 to February 2001, 52 elderly patients (> 80 years old) underwent the hip hemiarthroplasty after femoral neck fractures. There were 28 males and 24 females, with the average age of 84.2 years old (ranged from 80 - 95 years old). The fracture type was Garden III or IV, and all the patients underwent the hip hemiarthroplasty of domestic prosthesis. Before the operation, most of them were accompanied with pre-existed diseases. Harris hip score including symptoms and the ability of daily life at the one year after operation was adopted for the follow-up. Postoperative A-P and lateral X-ray of hip joint in different phase were also assayed. RESULTS: Forty-six patients (88.46%) were free of pain and satisfied their operations, only 6 patients (11.54%) complained about slight pain. Twenty-four patients (46.2%) were able to walk without any assistant, 24 patients (46.2%) managed to walk by walker, 4 patients (7.7%) could only lie on the bed or move by wheel chair. Postoperatively, patients with neurological diseases such as Parkinson dementia, Senile dementia, cerebrovascular diseases got poor result of the quality of life. However, the other comorbid diseases such as cardiovascular diseases, diabetes mellitus, chronic renal failure, chronic bronchitis did not affect the result. Thirty-eight patients had the postoperative X-ray when they were followed up. Postoperatively, the X-ray were taken from 3 months to 5 years and 6 months, averaged 54.2 months. Sclerotic line were discovered around the shaft of prosthesis only in 3 patients. No complications such as femoral head central dislocation or hip osteoarthritis were found. CONCLUSION: Operative treatment could be actively adopted for aged femoral neck fracture patients without surgical contraindication, which can contribute to obtain the motion ability, reduce complication caused by lying in bed, and keep a good quality of life.