基于股骨头置换的多学科综合治疗老年陈旧性股骨颈骨折  

Multi-disciplinarily comprehensive therapy based on femoral head arthroplasty for old femoral neck fracture in the elderly

作　　者：封沙[1] 潘福根[1] 王忆茗[2] 阎作勤[2] 陈峥嵘[2] 郭常安[2] 

机构地区：[1]复旦大学附属中山医院青浦分院骨科,上海201700 [2]复旦大学附属中山医院骨科

出　　处：《中华创伤杂志》2015年第10期921-924,共4页Chinese Journal of Trauma

基　　金：上海市医学重点专科建设计划资助项目，上海市科委医学引导类课题资助项目

摘　　要：目的评估以人工股骨头置换术为基础，多学科综合治疗合并严重基础疾病的老年陈旧性股骨颈骨折的效果和安全性。方法36例老年陈旧性股骨颈骨折患者，平均年龄78．2岁，平均受伤时间13．7个月，均合并1种及以上较严重的基础疾病。所有患者均接受人工股骨头置换术。回顾性分析围术期并发症，评估术后6个月髋关节功能。结果1例术后因严重肺部感染死亡，余35例发生电解质紊乱16例，低血压7例，心律失常4例，急性心功能衰竭2例，急性肾损伤1例，经正规治疗后均好转，安全度过围术期。髋关节Harris评分由术前的（22．0±6．8）分提高到术后6个月的（69．2±10．8）分（P〈0．01）。结论以人工股骨头置换术为基础的综合治疗，是合并有严重基础疾病的老年陈旧性股骨颈骨折的有效处理手段。Objective To investigate the effect and safety of comprehensive therapy based on femoral head arthroplasty in treating old femoral neck fracture in the elderly complicated with other severe basic medical conditions. Methods Thirty-six elderly patients with old femoral neck fracture were treated with femoral head arthroplasty. Mean age of the patients was 78.2 years, and mean duration since injury was 13.7 months. All the patients had at least one severe basic medical problem. Perioperative complications were retrospectively analyzed, and function of hip joint was evaluated 6 months after operation. Results One patient died because of severe pulmonary infection, while 16 electrolyte imbalance, 7 hypotension, 4 arrhythmia, 2 acute heart failure and 1 acute kidney injury were cured in the rest 35 patients. Harris hip score of the 35 patients increased from （ 22.0 ± 6.8 ） points pre-operatively to （69.2 ± 10.8 ） points 6 months post-operatively （P 〈 0.01 ）. Conclusions Comprehensive therapy based on femoral head arthroplasty is effective for old femoral neck fracture in the elderly suffering severe underlying diseases. Early treatment, perfect pre-operative preparation, correct manipulation and appropriate perioperative management play important roles.

关 键 词：关节成形术 置换 髋 股骨颈骨折 骨折愈合 

分 类 号：R687.4[医药卫生—骨科学]