双极人工股骨头置换术在老年不稳定型股骨转子间骨折中的应用及安全性

Application and Safety of Bipolar Artificial Femoral Head Replacement in the Elderly Unstable Intertrochanteric Fractures

摘要: 目的：探讨双极人工股骨头置换术在老年不稳定型股骨转子间骨折患者中的疗效及安全性。方法：回顾性分析2015年1月至2019年12月期间在我科收治的60例老年不稳定型股骨转子间骨折患者。受伤年龄75~90岁，平均81.3岁。按Evans-Jensen分型标准：IB型10例，IIA型14例，IIB型24例，III型12例。所有患者均接受人工股骨头置换治疗。结果：术后随访12~48个月(平均18.4个月)，均获得随访。术后1例发生切口不愈合，经严格清创换药后痊愈；1例发生人工关节脱位，经二次手术后痊愈；1例出现钢丝断裂，但未见假体松动或脱位。末次随访未见畸形、脱位、假体周围骨折、假体松动及下沉等并发症。Harris评分从术前平均27.01 (范围：15~38)分，提高到末次随访时平均89.0 (范围：69~95)分；其中优38例，良11例，可10例，差1例，优良率81.6% (49/60)。结论：双极人工股骨头置换治疗老年不稳定型股骨转子间骨折的效果良好，可获得良好的骨折复位固定，且并发症少，安全性高。

Abstract: Objective: To investigate the efficacy and safety of bipolar artificial femoral head replacement in the elderly patients with unstable intertrochanteric fractures. Methods: We retrospectively reviewed 60 elderly patients with unstable intertrochanteric fractures who were admitted to our department between January 2015 and December 2019. Age at injury ranged from 75 to 90 years, with a mean of 81.3. According to the Evans-Jensen classification criteria: 10 patients were type IB, 14 patients were type IIA, 24 patients were type IIB, and 12 patients were type III. All patients were treated with artificial femoral head replacement. Results: Patients were followed from 12 to 48 months (mean 18.4 months) after surgery and all were included in the study. After operation, 1 case had incision nonunion and recovered after strict debridement and dressing change; one case developed artificial joint dislocation and recovered after secondary operation; one case had steel wire fracture, but there was no prosthesis loosening or dislocation. No complications such as deformity, dislocation, periprosthetic fracture, prosthesis loosening and sinking were found in the last follow-up. The Harris score improved from a mean of 27.01 (range: 15~38) points preoperatively to a mean of 89.0 (range: 69~95) points at last follow-up; among them, 38 cases were excellent, 11 cases were good, 10 cases were fair, and 1 case was poor, with an excellent rate of 81.6% (49/60). Conclusions: The effect of bipolar artificial femoral head replacement in the treatment of the elderly unstable intertrochanteric fractures is good, and good fracture reduction and fixation can be obtained, with few complications and high safety.