Surgical Treatment and Outcomes of the Femoral Neck Fractures in the Elderly

老年人股骨頸骨折手術治療成果

劉堂桂(Tang-Kue Liu)；楊榮森(Rong-Sen Yang)

Femoral neck fractures ； Hip fracture ； Operation

Journal of Orthopaedic Surgery Taiwan

10卷1期（1993 / 03 / 01）

103 - 111

英文

髖部骨折乃是常見之骨折，此與老年人骨質疏鬆症具有密切關係。甚治療目標在於早日恢復其步行能力與自我照顧能力。骨折發生後早期施行手術與復健乃是改善預後的重要條件。本論文回顧臺大醫院骨科字1980年1月至1988年12月間共179例發生股骨頸部骨折老年人的首術治療成果。施行手術時病患年齡範圍自70歲至93歲(平均78.1歲)。其中男性共63例，女性126例；左側股骨頸骨折佔89例，右側則為92例。跌倒或是滑倒是主要的骨折原因(共163例)。手術治療方式包過Knowles鋼釘固定共32例，Moore半人工髖關節置換術式共77例；雙極心式半人工髖關節置換式共49例；全人工髖關節置換術共23例。臨床評估項目包括疼痛及步行能力的改善。結果發現，病患年紀越大時，其手術後疼痛與步行能力的改善越差。病人同時發生其他疾病時也會使治療預後變壞，尤其是中風，巴金森病或是老年性癡呆症時，都會令病人步行能力變差，結果也會影響手術治療之成效。其他因素如性別，受傷側別，以及延後治療的時間久暫等對治療結果皆無影響。由本系列並患研究分析所見。各種不同治療方式的治療成果並無差別。然而，接受Knowles鋼釘固定治療者發生併發症的比率較其他治療方式較高。因此髖部人工關節置換術為比較合老年人股骨頸骨折的治療方式，尤其是發生移位性股骨頸骨折的老年病患尤其適用。

A retrospective review of 179 aged patients with femoral neck fractures was performed. The patients’ ages at operation ranged from 70 to 93 years (mean 78.1 years). Fifty-three men and 126 women had 89 left hips and 92 right hips injured. Falling down or slipping was the major cause of fractures (163 patients). The treatment included 32 Knowles pinning; 77 Moore hemiarthroplasty;49 bipolar hemiarthroplasty; and 23 total hip arthroplasty (THA).The clinical outcomes of pain and ambulation were evaluated. The follow-up period ranged from 12 to 112 months (mean 47.7 months). The older age influenced the status of the pain and ambulation. Besides, the presence of the coexisted diseases worsened the prognosis, ambulation were affected most in those patients with cerebral vascular accidents (CVA), parkinsonism and senile dementia. The sex, injured side, and duration of delay of treatment did not affect the outcome of treatment. From this series, there was no definite evidence of differences of the clinical outcome among various treatment. However, the incidence of complications in those patients treated with Knowles pinning seemed higher than others. Arthroplasty seemed more appropriate treatment for the elderly patients, especially for those with displaced femoral neck fractures.