髋关节置换术治疗老年髋部骨折内固定失败

目的 评价采用髋关节置换术治疗老年髋部骨折内固定失败的临床效果.方法 回顾性分析2003年7月至2011年6月,采用髋关节置换术治疗老年髋部骨折内固定失败并获得完整随访资料者22例,男12例,女10例；行髋关节置换术的年龄为65～82岁,平均72岁；从骨折到行髋关节置换的时间为8～71个月,平均41个月.骨折内固定方法是多枚螺钉12例,滑动髋螺钉6例,股骨近端髓内钉2例,股骨近端钢板2例.失败原因是拉力螺钉切出股骨头7例,骨折不愈合6例,股骨头缺血性坏死5例,创伤性骨关节炎4例.术前患髋Harris评分平均37分(32～45分),采用非骨水泥型全髋置换l1例,骨水泥型全髋置换4例,非骨水泥型半髋置换4例,骨水泥型半髋置换3例.标准柄股骨假体1 5例,长柄股骨假体7例.结果 22例均获随访,随访时间1～5年,平均2.5年.末次随访时Harris评分平均88分(84～95分),优7例,良11例,可3例,差1例,优良率81.8％.无假体松动和下沉.结论 髋关节置换术是治疗老年髋部骨折内固定失败后的一种有效挽救关节功能的选择.

Hip Replacement for Failed Internal Fixation of Hip Fractures in Elderly

Objective To evaluate the results and complications of hip replacement for failed hip fractures in el- derly treated with internal fixation. Methods From July 2003 to June 2011,twenty two eldly patients（12 males and 10 females）were treated with hip replacement after the failed internal fixation of hip fractures eldly. The mean age was 72 years （range ,65~82 years） at the time of the hip replacement. The average interval from fracture to replace- ment was 41 months （range, 8~ 71 months）. 12 patients had been treated with multiple screws, 6 dynamical screw, 2 with intramedullary nail, 2 with plate and screws. There were implant cut out from the femoral head in 7 cases, nonunion of fractures in 6 cases,avascular necrosis of the femoral head in 5 cases and traumatic arthritis in 4 cases. The average preoperative Harris Hip Score was 37 （range, 32~45）,Uncemented total hip replacement were used in 11 cases,cemented total hip replacement were used in 4 cases and uncemented hemi-hip in 4 cases ,cemented hemi-hip in 3 cases. Standard prostheses were used in 15 case,and Long-stem prostheses in 7 case. Results Twenty-two patients were followed up for a minimum of 5 years after the hip replacement,with the mean period of 2.5 years （range, 1~5 yeas ） and 88 （range, 84~ 95） at the latest follow-up. According to Harris hip score standard features excellent in 7 cases,good in 11 cases,fair in 3 cases and poor in 1 case,and the excellent and good rate was 81.8%. No loosing and sinking was found in prostheses. Conclusion Hip replacement is an effective salvage procedure after the failed treat- ment of an hip fracture in elderly.