Taine W H, Armour P C
J Bone Joint Surg Br. 1985 Mar;67(2):214-7. doi: 10.1302/0301-620X.67B2.3980528.
The management of displaced subcapital fracture of the hip is still controversial because of the high incidence of complications after internal fixation or hemiarthroplasty. To avoid some of these complications we have used primary total hip replacement for independently mobile patients over 65 years of age. A total of 163 cases, operated on over four years, have been reviewed. There were relatively more dislocations after operation for fracture than after total replacement for arthritis, and these were associated with a posterior approach to the hip. Only seven revision operations have been required. Of 57 patients who were interviewed an average of 42 months after replacement, 62% had excellent or good results as assessed by the Harris hip score. All the others had major systemic disease which affected their assessment. This inadequacy of current systems of hip assessment is discussed. It is concluded that total hip replacement is the best management for a selected group of patients with this injury, and that further prospective studies are indicated.
由于髋关节囊下移位骨折内固定或半关节置换术后并发症发生率较高，其治疗方法仍存在争议。为避免部分此类并发症，我们对65岁以上能够独立活动的患者采用了一期全髋关节置换术。回顾了四年内共163例手术病例。骨折手术后脱位相对多于关节炎全髋关节置换术后，且这些脱位与髋关节后路手术有关。仅需7次翻修手术。在置换术后平均42个月接受访谈的57例患者中，根据Harris髋关节评分，62%的患者结果为优或良。其他所有患者均患有严重的全身性疾病，这影响了对他们的评估。本文讨论了当前髋关节评估系统的不足之处。得出的结论是，全髋关节置换术是这类特定损伤患者的最佳治疗方法，并且需要进一步开展前瞻性研究。
