Sancheti Kh, Sancheti Pk, Shyam Ak, Patil S, Dhariwal Q, Joshi R
Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashatra, India.
Indian J Orthop. 2010 Oct;44(4):428-34. doi: 10.4103/0019-5413.67122.
The management of unstable osteoporotic intertrochantric fractures in elderly is challenging because of difficult anatomical reduction, poor bone quality, and sometimes a need to protect the fracture from stresses of weight bearing. Internal fixation in these cases usually involves prolonged bed rest or limited ambulation, to prevent implant failure secondary to osteoporosis. This might result in higher chances of complications like pulmonary embolism, deep vein thrombosis, pneumonia, and decubitus ulcer. The purpose of this study is to analyze the role of primary hemiarthroplasty in cases of unstable osteoporotic intertrochanteric femur fractures.
We retrospectively analyzed 37 cases of primary hemiarthroplasty performed for osteoporotic unstable intertrochanteric fractures (AO/OTA type 31-A2.2 and 31-A2.3 and Evans type III or IV fractures). There were 27 females and 10 males with a mean age of 77.1 years (range, 62-89 years).
Two patients died due to unrelated cause (myocardial infarction) within 6 months of surgery and remaining 35 patients were followed up to an average of 24.5 months (range,18-39 months). The average surgery time was 71 min (range, 55-88 min) with an average intraoperative blood loss of 350 ml (range, 175-500 ml). Six patients needed blood transfusion postoperatively. The patients walked on an average 3.2 days after surgery (range, 2-8 days). One patient had superficial skin infection and one had bed sore with no other significant postoperative complications. One patient of Alzheimer's disease refused to walk and had a poor result. A total of 32 out of 35 patients (91%) had excellent to fair functional results and 2 had poor result with respect to the Harris hip score (mean 84.8±9.72, range 58-97). One patient who had neurological comorbidity refused to walk post operatively and was labeled as failed result.
Hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in elderly results in early ambulation and good functional results although further prospective randomized trials are required before reaching to conclusion.
老年骨质疏松性股骨粗隆间不稳定骨折的治疗具有挑战性，因为解剖复位困难、骨质质量差，且有时需要避免骨折部位承受负重应力。这些病例的内固定通常需要长期卧床休息或限制活动，以防止因骨质疏松导致植入物失效。这可能会增加肺栓塞、深静脉血栓形成、肺炎和压疮等并发症的发生几率。本研究的目的是分析初次半髋关节置换术在骨质疏松性股骨粗隆间不稳定骨折病例中的作用。
我们回顾性分析了37例因骨质疏松性不稳定股骨粗隆间骨折（AO/OTA 31-A2.2型和31-A2.3型以及Evans III型或IV型骨折）而进行初次半髋关节置换术的病例。其中女性27例，男性10例，平均年龄77.1岁（范围62-89岁）。
2例患者在术后6个月内因无关原因（心肌梗死）死亡，其余35例患者平均随访24.5个月（范围18-39个月）。平均手术时间为71分钟（范围55-88分钟），平均术中失血量为350毫升（范围175-500毫升）。6例患者术后需要输血。患者术后平均3.2天开始行走（范围2-8天）。1例患者发生浅表皮肤感染，1例患者出现压疮，无其他严重术后并发症。1例阿尔茨海默病患者拒绝行走，效果不佳。35例患者中共有32例（91%）Harris髋关节评分结果为优至良，2例结果较差（平均84.8±9.72，范围58-97）。1例患有神经合并症的患者术后拒绝行走，被判定为治疗失败。
老年骨质疏松性股骨粗隆间不稳定骨折行半髋关节置换术可实现早期活动并获得良好的功能结果，不过在得出结论之前还需要进一步的前瞻性随机试验。
