双动水泥型人工股骨头置换术治疗合并心肺脑疾病高龄股骨转子间骨折  

Cemented bipolar femoral head arthroplasty in treatment of senile intertrochanteric fracture with cardiopulmonary diseases

作　　者：张舜[1] 陈坤峰[2] 张传林[1] 段广超[1] 南运东[1] 

机构地区：[1]商丘市第一人民医院骨二科,476100 [2]商丘市第一人民医院急诊外科,476100

出　　处：《中华创伤杂志》2015年第6期531-535,共5页Chinese Journal of Trauma

摘　　要：目的探讨双动水泥型人工股骨头置换术治疗合并心肺脑疾病高龄股骨转子间骨折患者的临床效果。方法2005年1月-2013年10月收治75～86岁患心肺脑等疾病股骨转子间骨折患者23例，骨折按Evans分型：Ⅰ型3例，Ⅱ型9例，Ⅲa型5例，Ⅲb型2例，Ⅳ型3例，逆转子间型骨折1例。采用双动水泥型人工股骨头置换（置换组）；另选取同期在年龄、合并疾病相当的股骨近端锁定钢板内固定23例作为对照组。比较两组手术时间、术中出血量、术后引流量、引流管拔除时间、抗生素应用量、围术期并发症、卧床并发症、骨折内固定并发症、Harris评分。结果置换组与对照组比较，在平均手术时间（52．7min：52．0min）、平均术中出血量（160．9ml：156．5ml）、平均术后引流量（162．2ml：158．3m1）、平均引流管拔除时间（69．9h：68．9h）、平均Harris评分（73．7分：74．2分）等方面差异均无统计学意义（P〉0．05）。两组均预防应用抗生素5d。在平均下床时间（8．1d：109．3d）、围术期并发症发生率（19％：59％）、卧床并发症发生率（0：36％）、内固定并发症发生率（0：18％）方面置换组均明显低于内固定组（P〈0．05）。结论双动骨水泥型人工股骨头置换术治疗合并心肺脑等疾病高龄患者股骨转子间骨折可有效预防骨折内固定、围术期及卧床并发症，提高患者生存质量。Objective To evaluate the clinical outcomes of cemented bipolar femoral head arthroplasty in treatment of intertrochanteric fractures in elderly patients combined with heart, lung, brain and other diseases. Methods The study comprised 23 cases, aged 75-86 years old, treated with cemented bipolar artificial femoral head arthroplasty between January 2005 and October 2013 （ replacement group）. Evans＇ classification of the fracture was type Ⅰ in 3 cases, type Ⅱ in 9, type Ⅲ a in 5, type Ⅲ b in 2, type Ⅳ in 3 and reverse intertrochanteric fracture in 1. Additionally, 23 cases with the similar physical condition treated with anatomical locking plates were chosen as controls. For comparisons between groups, operation time, amount of bleeding, drainage volume, mean time to extract drainage tub, antibiotics dosage, perioperative complications, complications of lying in bed, fracture complications and Harris score were measured. Results There were no significant differences between replacement and control groups with respect to operation time （52.7 minutes vs 52.0 minutes）, amount of bleeding （ 160.9 ml vs 156.5 ml） , drainage volume （ 162.2 ml vs 158.3 ml） , Harris score （73.7 points vs 74.2 points）, time to extract drainage tub （69.9 hours vs 68.9 hours） （P 〉 0.05 ）. Both groups had 5 days of preventive antibiotic usage. Better results were observed in replacement group than in control group concerning mean time of ambulation （8.1 days vs 109.3 days ）, rate of perioperative complications （ 19% vs 59% ）, rate of bed rest complications （ 0 vs 36% ） and rate of internal fixation complications （0 vs 18% ） （ P 〈 0. 05 ）. Conclusion Cemented bipolar femoral head arthroplasty is effective to prevent the complications of internal fixation, bed rest as well as perioperation and improve the quality of life during the treatment of intertrochanteric fracture in elder patients with heart, lung, brain and other diseases.

关 键 词：股骨骨折 关节成形术 置换 老年人 

分 类 号：R687.3[医药卫生—骨科学]