髋关节成形术治疗血液透析患者髋部骨折的短期疗效

目的探讨髋关节成形术治疗血液透析患者髋部骨折的短期疗效.方法 回顾性总结采用全髋或者半髋置换术治疗血液透析后髋部骨折的患者18例,男11例,女7例;平均年龄74岁（47～90岁）.所有患者均为诊断为慢性肾衰竭、慢性肾脏病（CKD）Ⅴ期,术前平均接受血液透析治疗的时间为4.2年（6个月～8年）.其中股骨颈骨折患者13例,股骨转子间骨折5例.根据骨折类型及采用的手术方式,将患者分为3组：A组6例股骨颈骨折患者,采用全髋关节置换术;B组7例股骨颈骨折患者,采用人工股骨头置换术;C组5例股骨转子间骨折患者,采用股骨头置换术.结果 13例患者获得随访,平均随访时间4年（1～7.3年）,术后Harris评分平均（81.0±8.4）分,优3髋、良4髋,疼痛评分平均（42.0±1.8）分.术后出现的并发症有：4例术后血肿;1例皮肤浅部感染;泌尿系感染3例,肺部感染4例;4例患者在围手术期死亡.患者的Harris评分与年龄有关.结论 采用髋关节成形术治疗血液透析患者髋部骨折能尽早让患者下地活动,避免长期卧床或者坐轮椅带来的各种并发症,有效的提高了患者的生活质量.

Short-term outcome of arthroplasty for hip fractures in patients undergoing chronic hemodialysis

Objective To study the short-term outcome of arthroplasty performed for hip fracture patients undergoing chronic hemodialysis. Methods Eighteen patients who were undergoing hemodialysis were treated by arthroplasty for hip fracture. There were 11 males and seven females with the mean age of 74 years. All patients were diagnosed as chnoric renal failure, CKD stage V. Six femoral neck fracture cases were treated by total hip replacement, seven femoral neck fracture cases were treated by bipolar hip hemiarthroplasty, and five cases of intertrochanteric fracture were treated by bipolar hip hemiarthroplasty. Results Thirteen patients were ibllowed up for a mean time of 2.3 years. At the latest follow-up, three hips were rated as excellent and four hips were good. The mean Harris score was （81.0± 8.4） and the mean pain score was （42. 0 ± 3.8 ）. The complications included four postoperative hematoma with prolonged drainage, one superficial skin infection, three urinary infection and four pulmonary infections. Four patients died in perioperation period. The Hairis scores were related to patients＇ age. Conclusions The early outcomes of arthroplasty performed in patients undergoing hemodialysis are satisfactory. Arthroplasty makes it possible for the patients undergoing hemidialysis to exercise early and avoid complications caused by long-term lying in bed.