Cemented Bipolar Femoral Head Arthroplasty In Treatment Of Senile Intertrochanteric Fracture With Cardiopulmonary Diseases

BackgroundIntertrochanteric fracture accounting for about 50% of hip fracture is a common disease in the elderly population,about 90% occurred in a 65-year-old or older,Therefore,how to improve the efficacy of intertrochanteric fracture curation,and let patients get rid of the pain as soon as possible,restore the hip joint function,reduce the intertrochanteric fracture concurrent rate and case fatality rate have been a hot topic for many years..In 2005,Tim evaluated and compared the effect of two different methods forunstable intertrochanteric hip fractures of aged patients.The two methods containsthe long shaft bone cement artificial joint replacement and proximal femoral nail antirotation(PFNA).Compare projects including length of hospital stay,weight-bearing time,complications,and functional recovery and so on.The results indicated that no marked difference in two groups.In 1989,Haentjens compared treatment effects between partial hip replacement and internal fixation for the intertrochanteric fracture elderly over the age of 75 years.The result showed that patients who had the partial hip replacement heal quicker and lower rate in bedsore and other complications.The conclusion is that the results benefit from theearly ambulation and weight-bearing activities.In 1995 Stappaert compared partial hip replacement with compression hip screw in treatment of peritrochanteric fractures.there was no statistically significant difference in operative time,postoperative complications and case fatality rate in two groupsexcept higher transfusional rate.After that,from 2002 to 2013,Chan CK,Rodop,Beersnd KR respectively reported the advantage of bone cement fixed prosthesis replacement for the treatment of intertrochanteric fracture including early weight bearing,avoiding prolonged bed rest complications.They thought that tpartial hip replacement was an alternative way for internal fixation method.The results above answer a question: for the treatment of intertrochanteric fracture,both joint replacement and open reduction and fixation to treatintertrochanteric fractures have no absolute advantages.That means joint replacement could be chosen for the treatment of intertrochanteric fracture.ObjectiveThe purpose of this paper is to explore the surgical treatment method and clinical effect of the bipolar cemented artificial femoral head replacement for the intertrochanteric fracture elderly with heart,lung and brain diseases.MethodsWe calculate 23 cases of intertrochanteric fracture with heart,lung,brain and other diseases between 75-86 years old from January 2005 to October 2013,which all the patients were treated with cemented artificial femoral head arthroplasty.Modified classification system was used for all the case,3 cases in fractures type I,9 cases in fractures typeⅡ,5 cases in fractures type Ⅲa,2 cases in fractures type Ⅲb,3 cases in fractures type Ⅳ,1 cases in fractures type reverse oblique fractures of intertrochanteric,23 cases with the similar physical condition were treated with proximal femoral locking plate as the control group.The results were assessed according to the operation time,amount of bleeding,the postoperative drainage,the time of drainage tube pulled out,the dosage of antibiotics,postoperative complications,laid-in-bed complications,internal fixation complications,Harris scores after one year.By comparing the indicators of the two groups of incidence of postoperative infections(0:0),collodiaphysial angle,the postoperative degree of knee varus angle,the leg length discrepancy,we judged the results of operation whether associated with complications.ResultsThe two groups werenon significant differences(P>0.05)in the operation time(52.7min : 52.0min),amount of bleeding(160.9ml : 156.5ml),the postoperative drainage(162.2ml : 158.3ml).The dosage of antibiotics and the time of drainage tube pulled out had the similar outcomes.The two groups were statistically significant differences(P<0.05)in the time of ambulation(8.13 d : 109.3d),the rate postoperative complications(17.3% :56.44%),laid-in-bed complications(0 : 39%),internal fixation complications(0 : 17.4%).The two groups werenon significant differences(P>0.05)in the incidence of postoperative infections,collodiaphysial angle(128.02°:129.1°),the postoperative degree of knee varusangle(3.2°:4.1°),the leg length discrepancy(0.89cm、0.71cm).ConclusionIntertrochanteric fracture elderly with heart,lung and brain diseases,bipolar cemented artificial femoral head replacement has the similar surgical risk with the internal fixation.But the patients who accepted the replacement can weight bearing activity earlier.This can effectively prevent the rate postoperative complications,laid-in-bed complications and internal fixation complications.could effectively prevent internal fixation complications and laid-in-bed complications,and could improve the quality of life.the bipolar cemented artificial femoral head replacement has the similar long-term effects with the internal fixation.It should be the one of the choose of the treatment of intertrochanteric fracture elderly with heart,lung and brain diseases.