人工关节置换治疗老年不稳定型转子间骨折.docVIP

人工关节置换治疗老年不稳定型转子间骨折【摘要】 目的 总结人工关节置换治疗老年不稳定型转子间骨折的方法和疗效。方法 采用人工关节置换术治疗28例老年不稳定型转子间骨折,对手术时间、出血量、术后并发症及Harris关节功能评分进行观察、统计。结果 平均手术时间80 min,出血量400 ml,术后并发症主要为尿储留、电解质紊乱、血糖增高等,无一例临床并发症及人工关节置换特异性并发症发生。术后随访6个月~3年,未见假体松动、脱位,Harris评分平均87分。结论 人工关节置换术是治疗老年不稳定型转子间骨折的安全有效的方法,具有缩短术后恢复时间,早期行功能锻炼,避免卧床并发症的特点。 【关键词】人工关节置换术;股骨转子间骨折;老年人 【Abstract】 Objective To summarize the method and effect of artificial joint replacement for the treatment of unstable intertrochanteric fractures of the elderly.Methods The results of 28 arthroplasties in elderly patients with unstable intertrochanteric fractures were reviewed.The main operating time,the average blood loss,surgery complications and Harris joint function score were observed an counted.Results The mean operating time was 80 min,the average blood loss was 400 ml.There were no specific complications from bed rest and artificial joint replacement.The common postoperative complications were urinary retention,and electrolytic disorder,hyperglycemia,ect.The followed up period ranged 6 months to 3 years,no prosthesis had loosening and dislocation.The average score of post operation was 87 acoding to Harris standard.Conclusion Artificial joint replacement is an effective way for the treatment of unstable intertrochanteric fractures of the elderly.It can shorten the postoperative recovery time,and have a early line of functional exercise,and avoid complications of bed resting. 【Key words】Artificial joint replacement; Intertrochanteric fractures; Elderly 髋部骨折是老年人常见损伤之一,随着人口的老龄化,其发生率亦逐年上升,其中以股骨转子间骨折尤为明显,由于老年患者本身的多病性、骨质疏松的低强高脆性、免疫系统弱化等原因使股骨转子间骨折的治疗变得更为复杂、棘手。切开复位内固定术较广泛的应用于临床,虽较保守治疗的疗效显著,但对某些严重不稳定型骨折合并骨质疏松者,疗效尚不理想。Stern在1978年首次报道105例不稳定型股骨转子间骨折人工关节置换取得94%的满意率。自2003年10月至2007年9月,我科采用人工关节置换治疗老年不稳定型股骨转子间骨折28例,取得良好效果。 1 临床资料 1.1 一般资料 本组28例,男11例,女17例,年龄73~85岁,平均年龄80.5岁。骨折类型按Evans分型:Ⅲ型15例,Ⅳ型8例,Ⅴ型5例。致伤原因:平地摔伤24例,交通伤4例。其中合并骨质疏松25例,骨性关节炎8例,脑外伤1例,心血管疾病15例,呼吸系统疾病5例,内分泌系统疾病8例,神经系统疾病1例,慢性缺铁性贫血1例。 入院后常规行皮牵引或胫骨结节骨牵引及各项术前检查,并结合内科适当治疗糖尿病、高血压心脏病、电解质紊