人工双极股骨头置换术治疗老老年股骨颈骨折的疗效分析

【】　目的　探讨人工双极股骨头置换术治疗老老年（>80岁）股骨颈骨折的临床疗效。　方法　2006年1月－2009年12月采用人工双极股骨头置换术治疗23例老老年股骨颈骨折患者，其中男8例，女15例；年龄81~100岁，平均88岁。左侧10例，右侧13例。致伤原因走路摔伤20例，交通事故伤3例。骨折按Garden分型Ⅲ型14例，Ⅳ型9例。均为新鲜骨折，受伤至手术时间3~12d。术前均合并慢性内科疾病。　结果　术后切口均I期愈合，3例发生肺部感染，1例发生深静脉血栓形成，无切口感染及假体脱位。2例患者分别于术后5个月死于急性心肌梗死及术后1年死于高血压性脑溢血。余21例均获随访，随访时间12~48个月，平均26个月。X线片示假体位置良好。根据Harris髋关节评分标准优12例，良6例，可2例，差1例，优良率为85.7%。　结论　人工双极股骨头置换术治疗老老年股骨颈骨折手术时间短，可早期髋关节活动，减少了卧床并发症，提高了生存率，改善了患者生活质量，是一种较理想的治疗手段。【Abstract】　Objective　Todiscusstheclinicaleffectsofbipolarhemiarthroplastyfortreatmentoffemoralneckfractureinsuper-agedpatientswhowereover80yearsold.　Methods　FromJanuary2006toDecember2009,23casesoffemoralneckfracturewereoperatedbybipolarhemiarthroplasty.Amongthepatients,therewere8malesand15females,withtheiragerangedfrom81to100yearsoldaveragingat87.5years.Tenpatientshadleftfemoralneckfracture,and13hadrightfemoralneckfracture.Twentypatientshadtheinjurybecauseoffallingonthegroundwhilewalking,and3duetocaraccident.BasedonGardenclassification,therewere14casesoftypeⅢand9oftypeⅣfractures.Allfractureswerefresh.Theintervalbetweentheinjuryandoperationwas3to12days.Beforeoperation,allpatientshadconcomitantchronicdiseases.　Results　Allincisionshealedinthefirststagewith3casesoflunginfectionand1caseofdeepvenousthrombus,andwithoutincisioninfectionorprosthesisdislocation.Onepatientdiedofacutemyocardialinfarction5monthsafteroperationandtheotheronediedofhypertensivecerebralhemorrhage1yearafteroperation.Alltheremaining21patientswerefollowedupfor12to48monthsaveragingat26months.X-rayresultshowedagoodlocationoftheprosthesis.AccordingtotheHarrisscoringsystem,theresultswereverygoodin12cases,goodin6cases,fairin2casesandpoorin1cases,withatotaleffectiverateof85.7％.　Conclusions　Bipolarhemiarthroplastyisanidealmethodtotreatfemoralneckfractureinsuper-agedpatients.Itcanshortenoperationtime,facilitateearlymovementsofthehipjoint,decreasecomplicationrateduetolyinginbed,andimprovesurvivalrateandqualityoflife.