高龄粗隆间骨折股骨头置换从手术到死亡的临床研究  

Clinic study from operation to death of elderly patients with intertrochanteric fractures treated by hemiarthroplasty

作　　者：范少地[1] 刘志恒[1] 胡万华[1] 吴国忠[1] Fan Shaodi;Liu Zhiheng;Hu Wanhua;Wu Guozhong(Department of Orthopedics,the 451 hospital of PLA,Xi’an 710054,China)

机构地区：[1]解放军第451医院骨科,西安710054

出　　处：《中华关节外科杂志（电子版）》2018年第4期462-466,共5页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的观察80岁以上高龄股骨粗隆间骨折人工股骨头置换术从手术到死亡期间的临床治疗效果。方法对解放军第451医院骨科2003年12月至2010年12月完成的35例80岁以上高龄股骨粗隆间骨折采用人工股骨头置换术的患者进行了从手术到死亡3～11年的随访,观察死亡原因和死亡率,髋关节功能,X线表现等的改变。纳入标准:随访资料完整,经影像学诊断为股骨粗隆间骨折,年龄80岁以上。排除标准:失访者不予纳入。采用2检验的Fisher精确概率法对髋关节功能优良率进行比较分析。结果随访1～7年髋关节功能优良率可保持到80%～84. 4%,髋关节功能良好。而随访7年,80%的患者非手术原因死亡。该组35例患者在随访11年时全部死亡。髋关节Harris评分组间优良率显示术后1年和术后3年(P=0. 759)、术后3年和术后5年(P=0. 641)、术后5年和术后7年(P=0. 184)、术后7年和术后9年髋关节功能优良率比较差异无统计学意义(P=0. 311),7年组和11年组髋关节功能优良率比较差异无统计学意义(P=0. 858)。随着随访时间延长,X线异常发生率越来越高。结论高龄股骨粗隆间骨折患者预期寿命短,采用人工股骨头置换术可获得良好的关节功能,减少术后并发症,是一种很好的治疗方法。Objective To evaluate the clinical results from operation to death of the patients over 80 years old with hemiarthroplasty in intertrochanteric fractures.Methods Thirty-five cases over 80 years old with intertrochanteric fracture treated by the hemiarthroplasty were followed up for three to 11 years and all the cases were observed from operation to death.All the cases came from department of orthopedics of the 451 Hospital of PLA from December 2003 to December 2010.The reason and the rate of death,the function of hip and the changes of X-ray were observed.Inclusion criteria:complete follow-up data,imaging diagnosis of femoral intertrochanteric fractures,age of 80 years or older.Exclusion criteria:the patients who lost the interview are not included.Fisher exact probability method of 2 test was used to analyze the good hip function rate.Results From one to seven years after the operation,80.0%-84.4%patients had good hip function.After seven years follow-up,80%patients died and none of the death reason had relationship with the operation.All the 35 cases died after 11 years follow-up.Hip Harris assessment of the excellent rate between the groups showed:no statistically significant difference was found in the functional excellence rate of hip joint between 1-year group and 3-year group(P=0.759),or between 3-year group and 5-year group(P=0.641),or between 5-year group and 7-year group(P=0.184),or between 7-year group and 9-years group(P=0.311),nor between 7-year group and 11-years group(P=0.858).The X-ray showed more changes after longer term follow-up.Conclusion Hemiarthroplasty treating intertrochanteric fractures in the patients over 80 years old,who have less life expectancy,is a good method showing good hip function and less complications.

关 键 词：髋骨折 老年 关节成形术 置换 髋 临床研究 

分 类 号：R687.3[医药卫生—骨科学]