背景：对于老年不稳定型股骨转子间骨折，是采用传统的动力髋螺钉等内固定治疗，还是采用人工关节置换；是一期行置换，还是等待内固定治疗失败后采取补救性关节置换，目前国内外尚无统一标准。目的：观察一期人工关节置换修复老年不稳定型股骨转子间骨折的效果及预后。方法：2008年4月至2011年10月新疆昌吉州人民医院骨二科采用一期人工关节置换修复老年不稳定型股骨转子间骨折患者21例，21例中1例既往合并股骨头缺血性坏死和创伤性关节炎的患者采用生物型人工全髋关节置换，3例采用标准骨水泥型双极人工股骨头假体置换，17例采用生物型双极人工股骨头假体置换。所有人工关节、内固定材料及配套关节置换手术器械均为进口。置换后定期随访，以髋关节Harris评分评估髋关节功能。结果与结论：所有置换手术均由同组医师完成。手术时间30-60 min，平均42 min；手术切口8-15 cm，平均11 cm；术中出血量50-300 mL，平均150 mL；输血例数13例，平均每例患者住院期间输血1.5 U。1例合并高血压、冠心病及糖尿病的76岁患者于置换后第9天猝死(急性心肌梗死)，3例置换后第3天双下肢血管B超示小腿肌间静脉血栓形成，无假体松动、下沉、感染以及血栓等并发症发生。除1例死亡外其他20例均获得随访，随访时间6-49个月。出院前髋关节Harris评分(73±4)分；末次随访髋关节Harris评分(82±6)分。提示一期人工关节置换修复老年不稳定型股骨转子间骨折的效果肯定，但病例数仍较少，尚需进一步研究。作者建议，对于符合指征的患者，一期人工关节置换可考虑首选。%BACKGROUND:Conventional dynamic hip screw or artificial joint replacement can be used to treat unstable intertrochanteric fracture in aged patients. It remains unclear whether we should select one-stage replacement or remedial joint replacement after failture, and there is no unified standard globaly. OBJECTIVE: To observe the outcomes and prognosis of one-stage artificial joint replacement for unstable intertrochanteric fracture in aged patients. METHODS:From April 2008 to October 2011, 21 patients with unstable intertrochanteric fracture in aged patients were repaired with one-stage artificial joint replacement at the Second Department of Orthopedics, Changji Prefecture People’s Hospital. Among 21 patients, 1 patient previously combined with avascular necrosis of the femoral head and traumatic arthritis received biological artificial total hip replacement. Three cases were subjected to standard bone cement bipolar artificial femoral head replacement. 17 cases underwent biological bipolar artificial femoral head prosthesis replacement. Al artificial joint, internal fixation material and accessory joint replacement surgical instruments were purchased outside China. Al patients were folowed up regularly. Hip joint function was assessed by Harris hip score. RESULTS AND CONCLUSION: Al operations were completed by the same group of physicians. Operation time was 30-60 minutes, averagely 42 minutes. Incision length was 8 to 15 cm, averagely 11 cm. Average intraoperative blood loss was 50-300 mL, averagely 150 mL. The number of transfusion cases was 13. 1.5 U blood was transfused averagely in each patient during hospital stay. One 76-year-old patient combined with hypertension, coronary heart disease and diabetes suffered from sudden death due to acute myocardial infarction at 9 days after replacement. B ultrasound revealed venous thrombosis of calf muscle of double lower extremities at 3 days after replacement. No complications such as prosthetic loosening, sinking, infections and thrombosis were detected. Except 1 case died, the other 20 cases received folow-up for 6-49 months. Harris hip score was 73±4 before discharge and 82±6 during last folow-up. These data confirm that effects of one-stage artificial joint replacement for unstable intertrochanteric fracture in aged patients are affirmative, but the number of case is stil less, and deserves further investigations. We suggest that in patients with conformed indication, one-stage artificial joint replacement can be the first choice.
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