人工股骨头置换治疗老年粉碎性股骨粗隆间骨折的临床评价

目的 观察应用人工股骨头置换术治疗老年粉碎性股骨粗隆间骨折的效果，并对非骨水泥生物型长柄人工双极股骨头的疗效作出临床评价。方法 2000年9月～2003年11月采用人工股骨头置换术治疗118例股骨粗隆间不稳定粉碎性骨折患者，年龄70～84岁，平均76．1岁。分别应用非骨水泥生物型长柄人工双极股骨头(52例)和骨水泥人工双极股骨头(66例)。随访观察两组患者的住院时间、负重行走时间及并发症情况。结果 应用非骨水泥生物型长柄人工双极股骨头组的52例中，49例能行走；应用骨水泥人工双极股骨头组的66例中，41例能行走，22例因髋关节疼痛出现不同程度的功能障碍，影响行走功能。结论 应严格掌握病例的选择标准，人工股骨头置换术是合并严重骨质疏松的老年股骨粗隆间不稳定、粉碎性骨折的一种治疗方法，应用非骨水泥生物型长柄人工双极股骨头的效果较传统骨水泥人工双极股骨头佳。

Clinical evaluation of treatment of comminuted intertrochanteric femoral fracture in the elderly with hip hemiarthro-plasty

Objective To report the outcome of treatment of comminuted intertrochanteric femoral fracture in the elderly with hip hemiarthroplasty and to assess the efficacy of using non cemented bipolar femoral head prosthesis. Methods In the period from September 2000 to November 2003, 118 cases of intertrochanteric femoral fracture in the elderly were treated with hip hemiarthroplasty. The age of the patients ranged from 70 years to 84 years with an average of 76.1 years. The long stem non cemented bipolar femoral head prosthesis was employed in 52 cases and cemented ones in 66. During follow up, the duration of hospitalization, the time to start walking and complications were observed in both groups. Results 49/52 patients who had long stem non cemented bipolar femoral head prostheses were able to walk. Among the 66 patients who had cemented prostheses, 41 could walk at discharge, while the other 22 were unable to walk because of hip pain. Conclusion As long as the criteria of case selection been strictly handled, the hip semiarthroplasty can be a treatment option for comminuted intertrochanteric femoral fracture in the elderly with severe osteoporosis,however, the long stem non cemented femoral head prosthesis is superior to the cemented one.