人工股骨头置换治疗57例高龄股骨粗隆间粉碎性骨折  

Treatment for 57 senile patients with intertrochanteric comminuted fractures by artificial replacement of the femoral head

作　　者：林宏生[1] 张国威[1] 吴昊[1] 王国普[1] 刘宁[1] 康先启 

机构地区：[1]暨南大学附属第一医院骨科,广东广州510630 [2]增城市石滩医院外科,广东增城511330

出　　处：《暨南大学学报（自然科学与医学版）》2008年第6期598-601,共4页Journal of Jinan University(Natural Science & Medicine Edition)

摘　　要：目的：探讨人工股骨头置换治疗高龄股骨粗隆间粉碎性骨折的适应证及相关临床问题。方法：收集57例高龄股骨粗隆间粉碎性骨折病例资料进行回顾性分析。所有患者均在麻醉下采用骨水泥型人工股骨头置换治疗。结果：本组2例术中灌注骨水泥时出现毒性反应，经抢救后恢复正常；术后15例有不同程度的肺部感染，并有1例出现呼吸衰竭；1例出现心功能衰竭转内科治疗；3例出现深静脉血栓形成；9例有老年反应性精神障碍。以上并发症经治疗后治愈或缓解出院。术后下床时间5～14d，平均8d；住院时间14～35d，平均19d。3例失随访，1例在随访中死亡，53例完成随访。随访时间6个月～3年，平均随访时间1年5个月。49例恢复接近伤前状况，4例恢复后明显差于伤前状况。随访期内未发现感染、假体脱位及松动病例。结论：人工股骨头置换治疗高龄股骨粗隆间粉碎性骨折具有手术简单，术后能保持肢体长度，病人卧床时间短，并发症少，功能恢复快等优点，是治疗高龄股骨粗隆间骨折较理想方法，但高龄患者要重视原发病的治疗和并发症的处理。Aim ：To explore the clinical indications and related issues of intertroehanterie （IT） comminuted fractures treated with artificial replacement of the femoral head. Methods： To analyze clinical data of 57 cases of IT comminuted fractures treated by artificial replacement of the femoral head under anesthesia. Results： Two of 57 cases occured a toxic reaction while inserting cement and resumed by rescue. Fifteen cases appeared pulmonary infection, and 1 case respiratory failure, One case with heart failure received medicine treatment, Three cases occurred deep venous thrombosis （DVT）, Nine cases had ractive mental disorder. All of these complications were discharged Full-weight-bearing ambulation time were 5 Hospitalization period lasted 14 - 35 days（an average 1 case died, The other 53 cases were followed up from 6 cured or mitigated by medical interfering before - 14 days （an average 8 days） postoperative; 19 days）. Except that 3 cases lost follow-up and months to 3 years（ an average 17 months）. Forty nine cases resumed to the pre-injury status, four cases were worse apparently than the pre-injury status after the resumption. No case was found to be infected, the prosthesis dislocation or loosening within follow-up period. Conclusion：It is a preferable method for treating senile patients with IT comminuted fractures by artificial replacement of the femoral head, with advantages of simple surgical technic, being able to maintain the normal length of limbs, shortening bedridden time, fewer complications and earlier recovery, but treatment for primary diseases and complications should be emphasized.

关 键 词：高龄 股骨粗隆间骨折 人工股骨头 

分 类 号：R687.3[医药卫生—骨科学]