人工关节置换治疗95岁以上患者股骨粗隆间骨折
Treatment of femoral intertrochanteric fractures in elderly patients(over 95 years) with hip arthroplasty
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摘要: 目的: 报告人工关节置换治疗95岁以上患者股骨粗隆间骨折的疗效。方法: 本组10例,男3例,女7例,年龄96.5(95~99)岁行人工关节置换12侧(双侧2例),人工股骨头置换11侧,人工全髋关节置换1侧。每例患者均有5种以上不同程度的并存病,伤前基本都能扶手杖活动,部分生活自理。患者入院后,除1例骨折畸形愈合继发骨关节炎患者外,均在3 d内手术,有2例入院当天急诊手术。手术采用气管插管全麻,多功能监护仪监护。新鲜骨折者术中重建股骨大、小粗隆、骨水泥型双动人工股骨头置换。结果: 全部病例均顺利通过手术,7 d内下床者3例,8~14 d下床5例。并发症: 一过性精神障碍5例;肺部感染2例;引流管口延迟愈合2例;上述并发症经对症处理均治愈,住院期间死亡1例。随访8例,随访时间5~12个月。3例可自己扶助行器在室内活动;3例在他人保护下扶助行器活动;2例分别于出院后3、5个月因其它疾病死亡。结论: 人工关节置换治疗95岁以上患者股骨粗隆间骨折可降低死亡率,改善高龄患者生活质量。Abstract: Objective: To investigate treatment of femoral intertrochanteric fractures in elderly patients over 95 years old with hip arthroplasty.Methods: There were 10 cases in the group,3 males and 7 females,aged 95~99 years with an average of 96.5 years.Arthroplasty was performed in 12 sides(2 cases with both sides),of which,artificial femoral head was performed in 11 sides,and total hip joint replacement was performed in 1 side.11 sides in 9 cases were fresh comminuted femoral intertrochanteric fracture,according to the classification of Evans,there were 2 cases of type ⅢA,5 cases of type ⅢB and 4 cases type Ⅳ fractures.1 case was hip osteo-arthritis secondary to the malunion of femoral intertrochanteric fracture.All 10 patients had more than 5 kinds of concomitant diseases.They could walk with canes,and take care of themselves partly before the fracture.Of the 9 cases with fresh fractures,2 cases were operated on emergently on the day admitted to the hospital,and 9 cases were operated on within 3 days after admitted to the hospital.Careful examination,medical and aneathesiological consultations were taken to confirm the indications,and to adjust the patients′ conditions.Special attention should be paid to the preservation of large peri-trochanteric fragments during the operation and bone defects were stuffed with bone cement.Results: All operations were successful.3 cases began protected ambulation within 7 days,5 cases within 8-14 days postoperatively.Complications: psychological disorders after the operation in 5 patients,infection of the lung in 2 patients,and prolonged healing of the drainage in 2 patients.All the complications were gradually recovered after appropriate treatments.1 patient died during the period of hospitalization.8 cases were followed up for 5 to 12 months with an average of 7 months after discharged from hospital.3 patients could walk indoors with walking aid,3 patients could walk with walking aid and personal assistance.2 patient died of other diseases in 3,5 months,respectively.Conclusion: It′s an effective method to treat the intertrochanteric fracture with hip arthoplasty in elderly patients over 95 years.It can reduce the mortality,and improve the patients′ quality of life.
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