带股距加长柄半髋置换治疗老年性粗隆间骨折的临床疗效  

Cementless calcar - replacement hemiarthroplasty for the treatment of unstable intertrochanteric fractures in elderly patients

作　　者：阿吉木.克热木 单平联[1] 玉素甫阿吉.麦麦提热夏提 阿不都拉.阿不都克尤木 麦麦提热夏提.米吉提 

机构地区：[1]新疆喀什地区第一人民医院骨一科,喀什市迎宾大道66号844000

出　　处：《中国矫形外科杂志》2013年第18期1816-1819,共4页Orthopedic Journal of China

摘　　要：[目的]评估羟基磷灰石涂层带股距加长柄半髋置换治疗老年性不稳定型粗隆间骨折的临床疗效,探讨半髋置换处理此类骨折的适应证、围手术期处理以及假体选择。[方法]2006年6月~2010年6月在本院行HA治疗老年性不稳定股骨粗隆间骨折108例患者(108髋)。男36例,女72例。平均年龄(78±6.4)岁(75~89岁)。平均Singh指数(2.9±0.7)级(1~4级)。评估手术时间、术中出血量、输血量、术后开始负重时间、住院时间、术后并发症。临床功能评估采用Harris评分标准。影像学评估采用Engh评分系统来评估股骨侧假体的骨长入及假体稳定性。骨-假体界面的透亮线和骨溶解的评估按Gruen分区描述。[结果]平均随访时间3.7±2.4年(2~6年);平均手术时间(65±26)min(45~95 min);平均输血量(445±115)ml(350~620 ml);平均输血量(1.9±0.8)单位(1~3单位);术后平均开始负重时间(6.5±2.1)d(5~9 d);平均住院时间(9.8±3.2)d(7~15 d)。无坠积性肺炎、褥疮和深部感染等并发症发生。平均Harris评分(85±9.8)分(75~98分),优良率达88.9%。X线片检查示:随访中共有2例脱位(术后15 d^1.5个月内),手法复位后未再次脱位;所有患者假体周围均无骨溶解、放射学透亮线、假体松动以及髋臼磨损征象。[结论]对于老年性不稳定型股骨粗隆间骨折,采用半髋治疗可以取得满意的临床疗效,患者可以早期下床活动,降低病残率和病死率。同时作者建议,为了简化手术程序,以及使假体能达到即刻稳定,最好选用双涂层带股距加长柄人工双极股骨头假体。[Objective]To evaluate the clinical outcomes,indications,perioperative management,and choice of prosthesis in patients who underwent cementless calcar-replacement hemiarthroplasty for unstable intertrochanteric fractures.[Method]We retrospectively reviewed the data of 108 patients（108 hips） who underwent cementless calcar-replacement hemiarthroplasty for unstable intertrochanteric fractures between June 2006 and 2010.The mean age of the patients was 78 ± 6.4 years.The mean Singh index was 2.9 ± 0.7.Clinical outcomes were assessed using the Harris hip scoring system.The femoral stems were evaluated radiographically using the system of Engh,and the bone-prosthesis interface was evaluated for radiolucencies and recorded according to the zonal system described by Gruen.Additionally,operative time,blood loss,transfusion,postoperative loading time,duration of hospital stay,and postoperative complications were evaluated.[Result]The mean duration of follow-up was 3.7 ± 2.4 years.The mean operative time,blood loss,transfusion,postoperative loading time,and duration of hospital stay were 65 ± 26 min,445 ± 115 ml,1.9 ± 0.8 U,6.5 ± 2.1 days,and 9.8 ± 3.2 days,respectively.There were no complications of hypostatic pneumonia,bedsores,or deep infection.The average postoperative Harris hip score was 85 ± 9.8 points.Of the 108 hips,39 were excellent,57 were good,and 12 were fair.Additionally,the incidence of good to excellent outcomes was 88.9%.There were no signs of loosening in the hips;however,posterior dislocation occurred in 2（1.9%） hips.[Conclusion]Cementless calcar-replacement hemiarthroplasty is an excellent choice for the treatment of unstable intertrochanteric fractures in elderly patients.Additionally,it can be used to restore the function of the hip and improve quality of life.

关 键 词：股骨粗隆间骨折 不稳定 髋关节置换 半髋 老年患者 

分 类 号：R687.3[医药卫生—骨科学]