人工股骨头置换治疗高龄不稳定股骨转子间骨折  

Artificial femoral head replacement for the treatment of unstable intertrochanteric fractures in aged patients:a report 40 cases

作　　者：孙玉明[1] 蒋东明[2] 毛国庆[2] 

机构地区：[1]南京中医药大学中医骨伤科教研室,江苏南京210029 [2]江苏省中医院骨伤科

出　　处：《中国骨伤》2009年第12期935-937,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨人工股骨头置换术治疗股骨转子间骨折的手术操作、适应证以及早期疗效。方法:2001年1月至2008年10月采用人工股骨头置换术治疗高龄不稳定股骨转子间骨折40例。男9例,女31例;年龄75～95岁,平均81.1岁。骨折后入院时间3～48h,平均11.5h。按Evans分型:Ⅱ型8例,Ⅲ型21例,Ⅳ型11例。入院后至手术时间4～8d,平均4.8d。通过术后随访,观察患者髋部活动能力,并根据Harris评分标准对髋关节综合功能进行评定。结果:40例均顺利通过手术,术后下床时间4～7d,平均5.9d。31例术后随访6个月,无假体松动、脱位、假体周围骨折发生,14例恢复到受伤前的活动水平,有17例出现了髋关节活动能力下降。术后4个月髋关节活动能力平均恢复(66.67±26.35)%,术后6个月髋关节活动能力平均恢复(76.08±25.62)%。术后6个月对髋关节进行Harris评分,其中伤前髋部活动能力正常的10例患者优5例,良3例,可2例。结论:人工股骨头置换术治疗高龄不稳定股骨转子间骨折手术过程安全,并发症少,髋关节功能恢复速度较快,恢复程度较高。Objective：To study the operative procedures,indicatrions and short term effects of the artificial femoral head replacement for the treatment of unstable intertrochanteric fracture in aged patients.Methods：From January 2001 to October 2008,40 patients with unstable intertrochanteric fractures were treated with artificial femoral head replacement.Among the patients,9 patients were male and 31 patients were female,ranging in age from 75 to 95 years,averaged 81.1 years.The duration from injured to the hospitalization ranged from 3 to 48 hours,with a mean of 11.5 h.According to Evans classification,8 patients were typeⅡ,21 typeⅢ,and 11 type Ⅳ.The duration from hospitalization to operation ranged from 4 to 8 days,averaged 4.8 day.After the operation,the hip motion was observed and the preoperative and postoperative Harris scores were compared.Results：All the patients were operated successfully,and were kept in bed about 4 to 7 days,5.9 days in average.Thirty one patients were followed up for 6 months without loose or dislocation of prothesis,periprosthetic fractures.Fourteen patients resumed to normal activity of the hip joint while 17 patients showed the declination of hip movement.Their hip movements recovered to（66.67±26.35）% at 4 months after operations and（76.08±25.62）% at 6 months.Among 10 patients with normal ability of hip joints before their injuries were valuated with Harris system at 6 mouths after operations,the results were：5 excellent,3 good and 2 poor.Conclusion：Artificial femoral head replacement for unstable intertrochanteric fractures in aged patients is effective in the recovery of hip joint function in short time with earlier walking and decreased complications.

关 键 词：股骨骨折 关节成形术 置换 髋 老年人 骨科手术方法 

分 类 号：R683.42[医药卫生—骨科学] R743.350.5[医药卫生—外科学]