目的 通过观察人工股骨头置换术治疗A2型高龄股骨粗隆间粉碎性骨折的疗效,探讨A2型高龄股骨粗隆间粉碎性骨折的治疗策略.方法 自1999年1月～2010年4月对23例A2型高龄粗隆间骨折采用人工股骨头置换术,男8例,女15例,年龄75～99岁,平均年龄78.5岁.按AO分型:A2.1型8例,A2.2型12例,A2.3型3例.致伤原因:跌伤19例,车祸伤4例.观察手术时间、术中出血、术后卧床时间及治疗效果并采用Harris评分进行评定.结果 23例高龄病人均安全度过围手术期,其中1人术后3个月死于癫痫.22例随访8～18月,平均12月,术后8个月Harris评分,优17例,良3例,可2例,差0例,优良率91％.结论 人工股骨头置换术治疗A2型骨折能达到即刻稳定的目的,可满足肢体早期负重活动,具有操作简单、手术时间短、出血量少等优点,对于高龄患者的治疗是一种好的选择.%Objective Through observing the application and efficacy of artificial femoral head replacement in the treatment of comminuted intertrochanteric hip fractures, to discuss the treatment strategy of comminuted intertrochanteric hip fractures of type A2 in eldly patients. Methods Retrospective study the 23 patients with comminuted intertrochanteric hip fractures of type A2 were operated by artificial femoral head replacement. The 23 patients include 8 males and 15 females with age range from 75-99 yearsC mean 78.5 years 1 According to AO Type, 8 cases was classified as type A2.1; 12 cases type A2.2; 3 cases type A2.3. Blood loss, operation time and functional recovery of the hip joint were observed. Result Patients were followed up averaged for 8~18months.Only 1 patient died of epilepsy; the remaining patients restore the original life skills. Postoperative joint function was evaluated with Harris Hip Scora with the satisfactory rate of 91%. Conclusion The clinical treatment of comminuted intertrochanteric hip fractures of type A2 with artificial femoral head replacement, is safer, little operation time, little bleeding volume and recovered quickly. Artificial femoral head replacement is a feasible and effective alternative for those patients with comminuted intertrochanteric hip fractures of type A2.
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