加长柄人工双极股骨头置换治疗高龄股骨粗隆间粉碎性骨折VIP免费

ChineseJournalofReparativeandReconstructiveSurgery,June2008,Vol.22,No.6·692·•论著•加长柄人工双极股骨头置换治疗高龄股骨粗隆间粉碎性骨折尹庆伟江毅肖联平田永刚福嘉欣李晓栋韩立强刘智【摘要】目的探讨人工股骨头置换治疗老年股骨粗隆间粉碎性骨折的疗效。方法2004年2月－2006年3月，应用加长柄骨水泥型双极半髋置换治疗高龄股骨粗隆间粉碎性骨折89例。男34例，女55例；年龄70～92岁，平均82.6岁。新鲜骨折76例，陈旧性骨折13例。骨折按改良Evans-Jensen分型：Ⅲ型32例，Ⅳ型57例。骨质疏松Singh指数分级：Ⅳ级24例，Ⅲ级46例，Ⅱ级19例。损伤至手术时间4～36d，平均6.5d。结果手术时间50～70min，平均62min；出血量100～250mL，平均150mL。术后88例切口Ⅰ期愈合，1例术后切口深部感染，经二次手术翻修后愈合。住院时间16～25d，平均18.6d。术后钢丝断裂及骨质切割松动失效各1例，临床无不适症状未予处理。2例术后第2～3天出现精神症状、术后1周内泌尿系统和呼吸系统感染各1例，经对症处理后痊愈。85例获随访14～39个月，平均26.5个月。髋关节功能按Harris评分：优16例，良56例，中12例，差1例，优良率84.7%。结论加长柄人工双极股骨头置换是治疗高龄股骨粗隆间粉碎性骨折的一种有效方法，但须严格掌握手术适应证和术中操作技巧。【关键词】老年股骨粗隆间骨折人工股骨头置换中图分类号：R687.4R683.42文献标志码：ATREATMENTOFINTERTROCHANTERICCOMMINUTEDFRACTUREINAGEDPATIENTSBYREPLACEMENTOFARTIFICIALLONG-STEMBIPOLARFEMORALHEAD/YINQingwei,JIANGYi,XIAOLianping,TIANYonggang,FUJiaxin,LIXiaodong,HANLiqiang,LIUZhi.DepartmentofOrthopaedics,theThirdCenterHospitalofTianjin,Tianjin,300170,P.R.China.Correspondingauthor:YINQingwei,E-mail:yqw1233068@sina.com【Abstract】ObjectiveTodiscusstheclinicaleffectofhiparthroplastyforthetreatmentofintertrochantericcomminutedfractureinagedpatients.MethodsFromFebruary2004toMarch2006,89caseswithintertrochantericcomminutedfracturesweretreatedbyreplacementofartificiallong-stembipolarhiphemiarthroplastywithbonecement,including34malesand55females,withtheaverageageof82.6years(rangingfrom70yearsto92years).Therewerefreshfracturesin76casesandoldfracturesin13cases.Accordingtoimproving-classificationofEvans-Jensen,therewere32caseswithtypeIIIfractureand57withtypeIV.OsteoporosiswasgradedbySingh-index,andtherewere24caseswithlevelIV,46withlevelIIIand19withlevelII.Theoperationwasdelayedfrom4daysto36days(6.5daysonaverage)aftertheinjury.ResultsThesurgerytimelastedfrom50minutesto70minutes(62minutesonaverage).Bleedingvolumewasfrom100mLto250mL(150mLonaverage).Thetimeinhospitalwasfrom16daysto25days(18.6daysonaverage).Allincisionprimarilyhealedexcept1casewhichdelayedunionbyrevisionwithinfection.Steelwireruptureoccurredin1case,invalidationin1case.Theywerenottreatedbecausetherewerenouncomfortablesymptoms.Theconsciousnessdisabilityhappenedin2cases2to3daysaftertheoperation,2casewiththeinfectionforthesystemofurineandbreath1weekafteroperation,werehealedthroughthetreatment.Eighty-fivecaseswerefollowedupfor14monthsto39months(26.5monthsonaverage).ThefunctionofthehipwasgradedbythesystemofHarrisandthechoicenessratewas84.7%(excellentin16cases,goodin56cases,fairin12casesandpoorin1case).ConclusionThetreatmentofintertrochantericcomminutedfractureintheagedpatientsbyreplacementoflong-stembipolarfemoralheadprosthesisiseffective,butindicationsandtechniquesoftheoperationmustbepaidmuchattentionto.【Keywords】AgednessIntertrochantericfractureReplacementofartificialfemoralhead随着社会人口的老龄化，高龄者（≥70岁）因骨质疏松导致髋部骨折发病率越来越高，统计资料表明作者单位：天津市第三...