人工股骨头置换治疗老年股骨转子间粉碎性骨折(1)
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【摘要】 目的 探讨骨水泥型长柄人工股骨头置换治疗老年股骨转子间骨折的疗效。方法 本组36例,男11例,女25例;年龄75~90岁,平均79岁。骨折按Evens分类:Ⅲ型27例,Ⅳ型9例。采用髋关节后外侧切口,术中注意将大小转子复位固定,股骨矩重建,并采用骨水泥型长柄双极人工股骨头置换。结果 全部顺利通过手术,手术时间50~110 min,平均65 min。36例均获随访,时间6~26个月,平均18个月。随访期间无关节脱位,假体松动断裂及感染,大部分患者恢复到术前活动水平。结论 骨水泥型人工股骨头置换治疗老年股骨转子间粉碎性骨折疗效满意,能最大限度恢复患者关节功能,改善患者生活质量,减少并发症,降低病死率。
【关键词】人工股骨头置换术;股骨骨折;老年人
Artificial femoral head replacement for treatment of comminuted fractures of femur in the elderly
GUO Wan xing,WANG Hong,XIAO Sheng Jie.Lufeng People’sHospital,Guangdong 516500,China
【Abstract】 Objective To investigate the long handled cement artificial femoral head replacement therapy in elderly intertrochanteric femoral fractures.Methods 36 cases,11 cases were male,female 25 cases; the age were 75~90 years old,the average age of 79 year old.Fracture classification according to Evens:Ⅲ type 27 cases,Ⅳ type 9 cases.The use of lateral hip incision,intraoperative attention to the size of the rotor will be reset fixed moment femur reconstruction,and the use of bone cement based long bipolar artificial femoral head replacement.Results All patients passedsurgery,with operative time 50~110 min,the average 65 min.36 cases were followed up 6~26 months,an average of 18 months.No follow up of dislocation,fracture and loosening of prosthesis infection were found,most patients returned to preoperative activity levels.Conclusions Bone cement treatment of artificial femoral head replacement for comminuted fracture of femur in the elderly has the effect of satisfaction with patients to maximize the restoration of joint function and improve quality of life of patients and reduce complications and reduce mortality.
【Key words】 Artificial femoral head arthroplasty; Femoral fracture; Elderly
本院自2006年1月至2009年1月采用骨水泥型长柄双极人工股骨头置换术治疗老年股骨转子间粉碎性骨折36例,取得满意效果。现报告如下。
1 临床资料与方法
1.1 一般资料 本组男11例,女25例;年龄75~90岁,平均79岁。致伤原因:滑倒跌伤12例,高处摔伤18例,交通伤6例。骨折按Evens分型:Ⅲ型27型,Ⅳ型9例。Singh指数Ⅱ级12例,Ⅲ级16例,Ⅳ级8例。31例合并有不同程度的内科疾病,包括慢支肺气肿、高血压病、糖尿病、冠心病、陈旧性脑梗死等。
1.2 手术方法 所有病例术前均行患肢皮肤牵引,完善有关检查,了解各重要器官功能,积极治疗内科疾病,病情许可情况下尽早手术。手术麻醉大部分采取硬膜外麻醉,个别心肺功能欠佳者采用全麻。手术时患者取健侧卧位,采用髋关节后侧切口,沿臀大肌纤维走向分开进入,切断外旋短肌群附着点,显露关节囊并切开。在小转子上方1~1.5 cm处切断股骨领,取出股骨头,保护好大、小转子等较大的骨折块及附着筋膜,注意不要轻易去除有肌肉附着的骨折块 ......
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