老年骨质疏松性髋部骨折的优化治疗方案

doi:10.3969/j.issn.2095-4344.2013.48.021

中国组织工程研究 ›› 2013, Vol. 17 ›› Issue (48): 8429-8436.doi: 10.3969/j.issn.2095-4344.2013.48.021

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇下一篇

老年骨质疏松性髋部骨折的优化治疗方案

陈鹏¹，刘文和²，颜林淋³，郭志文¹，唐新文¹，胡伟文¹，曹锡文¹，王福剑1，李杨¹，陈家玉⁴

湘南学院附属医院，¹骨科，³超声诊断室，湖南省郴州市 423000；²暨南大学医学院附属清远人民医院骨科二区，广东省清远市 511518；⁴湘南学院临床医学系，湖南省郴州市 423000

出版日期:2013-11-26 发布日期:2013-11-26
通讯作者: 陈家玉，主任医师，教授，硕士生导师，湘南学院临床医学系, 湖南省郴州市 423000
作者简介:陈鹏★，男，1981年生，湖南省耒阳市人，汉族，2009年南华大学毕业，硕士，主治医师，主要从事骨与关节损伤的基础与临床研究。
基金资助:
湖南省科技厅立项支助项目(2012TP4021-4)*；郴州市科技局立项支助项目(2012CT116)*

Optimized surgical treatment for osteoporotic hip fractures in the elderly

Chen Peng¹, Liu Wen-he², Yan Lin-lin³, Guo Zhi-wen¹, Tang Xin-wen¹, Hu Wei-wen¹, Cao Xi-wen¹, Wang Fu-jian¹, Li Yang¹, Chen Jia-yu⁴

1 Department of Orthopedics, Affiliated Hospital of Xiangnan University, Chenzhou 423000, Hunan Province, China
2 Department of Orthopedics, People’s Hospital of Qingyuan, Medical College of Jinan University, Qingyuan 511518, Guangdong Province, China
3 Department of Ultrasonography Diagnosis, Affiliated Hospital of Xiangnan University, Chenzhou 423000, Hunan Province, China
4 Department of Clinical Medicine, Xiangnan University, Chenzhou 423000, Hunan Province, China

Online:2013-11-26 Published:2013-11-26
Contact: Chen Jia-yu, Chief physician, Professor, Master’s supervisor, Department of Clinical Medicine, Xiangnan University, Chenzhou 423000, Hunan Province, China iudoct@126.com
About author:Chen Peng★, Master, Attending physician, Department of Orthopedics, Affiliated Hospital of Xiangnan University, Chenzhou 423000, Hunan Province, China 198122741@163.com
Supported by:
the Supportive Program of Hunan Provincial Science and Technology Bureau, No. 2012TP4021-4*; the grant from the Science and Technology Department of Chenzhou City, No. 2012CT116*

摘要/Abstract

摘要：

背景：目前国内外学者对于老年性髋部骨折越来趋向于积极的手术治疗。手术治疗首先要根据不同骨折部位、骨折类型、不同年龄和是否合并有内科基础疾病从而选择不同的固定方式，对于老年性髋部骨折治疗的成败起到非常重要的作用。
目的：探讨老年骨质疏松性髋部骨折的优化治疗方案。
方法：2000年1月至2012年1月根据具体情况采用不同方法治疗老年骨质疏松性髋部骨折176例，年龄(76.7±6.3)岁。股骨转子间骨折84例，其中保守治疗7例，动力髋螺钉内固定34例，空心加压螺钉固定18例，解剖钢板内固定7例，人工股骨头置换12例，人工全髋关节置换6例。股骨颈骨折92例，其中双极人工股骨头置换40例，人工全髋关节置换37例，空心加压螺钉固定15例。不同治疗方法的治疗效果按Harris髋关节功能评分标准评定，并观察患者并发症发生情况。
结果与结论：股骨转子间骨折76例，股骨颈骨折85例获随访，随访时间8-26个月。内固定治疗的平均愈合时间为(5.7±1.3)个月。3例发生治疗后感染，1例治疗后10 d并发心肺功能衰竭死亡。不同治疗方法的并发症包括股骨头切割、围术期骨折，内固定或假体松动、术后骨折、股骨头缺血坏死、髋内翻、下肢短缩、骨折延期愈合及对髋再骨折等。双极人工股骨头置换与人工全髋关节置换患者的并发症发生率显著低于保守治疗、空心加压螺钉、解剖钢板及动力髋螺钉置入内固定患者(P < 0.05)。双极人工股骨头置换与人工全髋关节置换患者的Harris评分优良率显著高于保守治疗、空心加压螺钉、解剖钢板及动力髋螺钉置入内固定患者(P < 0.05)。而保守治疗、空心加压螺钉、解剖钢板及动力髋螺钉置入内固定患者相互之间的并发症发生率、Harris评分优良率比较，双极人工股骨头置换与人工全髋关节置换患者的并发症发生率、Harris评分优良率比较，差异无显著性意义(P > 0.05)，提示老年骨质疏松性髋部骨折需要积极的综合治疗，对于高龄股骨颈骨折患者最好采用双极人工股骨头置换或人工全髋关节置换治疗为宜。

关键词: 骨关节植入物, 骨与关节临床实践, 骨质疏松, 髋部骨折, 手术, 内固定, 老年, 综合治疗, 省级基金

Abstract:

BACKGROUND: Active surgical treatments are preferred for elderly hip fractures. Individual fixation method is chosen according to fracture site, type, age and whether there are basic diseases in internal medicine, which plays an important role in the successful treatment of elderly hip fractures.
OBJECTIVE: To explore the effects of optimized surgical treatment on osteoporotic hip fracture in the elderly.
METHODS: Totally 176 patients with osteoporotic hip fracture were treated by different methods between January 2000 and January 2012, including 63 males and 113 females, with a mean age of (76.7±6.3) years. Out of the 84 cases of interchanteric fracture, seven cases were treated with conservative methods, 34 cases were treated with dynamic hip screw internal fixation, 18 cases were treated with cannulated screw internal fixation, seven cases were treated with anatomical plate internal fixation, 12 cases were treated with bipolar femoral placement, and six cases were treated with total hip arthroplasty. Out of the 92 cases with femoral neck fractures, 40 cases were treated with bipolar femoral placement, 37 cases were treated with total hip arthroplasty and 15 cases were treated with cannulated screw internal fixation. Modified Harris hip function scores were used to evaluate the therapeutic effects of different treatment methods. Complications were observed.
RESULTS AND CONCLUSION: Seventy-six cases of interchanteric fractures and 85 cases of femoral neck fractures were followed-up for 8-26 months with an average of (5.7±1.3) months. Three cases suffered from post-operative infection, and one case died due to cardio-pulmonary failure in 10 days after operation. Both intraoperation and postoperative complications included femoral head cutting, intraoperative fracture, internal fixation and prosthetic loosening, postoperative fracture, avascular necrosis of femoral head, coxa vara, legs shorten, and delayed fracture healing. The incidence rates of complications in patients undergoing bipolar femoral placement and total hip arthroplasty were significantly lower than those treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P < 0.05). The outcomes of the treatment according to Harris scoring criterion were better in patients treated with bipolar femoral placement and total hip arthroplasty than in patients treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P < 0.05). No significant differences were found in the incidence rate of complications and Harris scores among patients treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P > 0.05). No significant differences were found in the incidence rate of complications and Harris scores between patients treated with bipolar femoral placement and total hip arthroplasty (P > 0.05). These findings indicate that the treatment of osteoporotic hip fracture in the elderly can achieve satisfactory results if the comprehensive therapies are given. Bipolar femoral placement and total hip arthroplasty are preferred for elderly femoral neck fractures.

Key words: hip fractures, osteoporosis, arthroplasty, replacement, hip, hip prosthesis, femur

中图分类号:

R318

陈鹏，刘文和，颜林淋，郭志文，唐新文，胡伟文，曹锡文，王福剑，李杨，陈家玉. 老年骨质疏松性髋部骨折的优化治疗方案[J]. 中国组织工程研究, 2013, 17(48): 8429-8436.

Chen Peng, Liu Wen-he, Yan Lin-lin, Guo Zhi-wen, Tang Xin-wen, Hu Wei-wen, Cao Xi-wen, Wang Fu-jian, Li Yang, Chen Jia-yu. Optimized surgical treatment for osteoporotic hip fractures in the elderly[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(48): 8429-8436.

图/表（结果） 2

Quantitative analysis of participants

Totally 176 patients with osteoporotic hip fracture were included in the study, including 84 cases of interchanteric fracture and 92 cases of femoral neck fracture. Seventy-six cases of interchanteric fracture and 84 cases of femoral neck fracture were followed up for 8-26 months.

Follow-up results

Out of the 76 cases of interchanteric fracture, six cases were treated by conservative methods, 30 cases by dynamic hip screw internal fixation, 17 cases by cannulated screw internal fixation, six cases by anatomical plate internal fixation, 11 cases by bipolar femoral placement, and six cases by total hip arthroplasty. Out of the 85 cases with femoral neck fracture, 36 cases were treated by bipolar femoral placement, 34 cases by total hip arthroplasty and

15 cases by cannulated screw internal fixation. The average fracture healing time was (5.7±1.3) months in the internal fixation cases.

Complications

Both intraoperation and postoperative complications included femoral head cutting, intraoperative fracture, internal fixation and prosthetic loosening, postoperative fracture, avascular necrosis of femoral head, coxa vara, legs shorten, delayed fracture healing, contralateral hip re-fracture. The incidence rates of complications in patients undergoing bipolar femoral placement and total hip arthroplasty were significantly lower than those treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P < 0.05). No significant differences were found in the incidence rate of complications among patients treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P > 0.05). There was also no significant difference in the incidence rate of complications between patients treated with bipolar femoral placement and total hip arthroplasty (P > 0.05; Table 1).

Therapeutic effects

The data are detailed in Table 2.

According to Harris scoring standard, the outcomes of the treatment were excellent in two cases, good in two, fair in one, and poor in one, and the excellent-good rate was 66.67% (4/6) resulted from conservative treatment. The outcomes were excellent in 11 cases, good in 12, fair in six, and poor in three, and the excellent-good rate was 71.88% (23/32) resulted from cannulated screw internal fixation. The outcomes were excellent in three cases, good in one, fair in one, and poor in one, and the excellent-good rate was 66.67% (4/6) resulted from anatomical plate internal fixation. The outcomes were excellent in 13 cases, good in 10, fair in four, and poor in three, and the excellent-good rate was 76.67% (23/30) resulted from dynamic hip screw internal fixation. The outcomes were excellent in 23 cases, good in 15, fair in five, and poor in four, and the excellent-good rate was 80.85% (38/47) resulted from bipolar femoral placement. The outcomes were excellent in 21 cases, good in 14, fair in three, and poor in two, and the excellent-good rate was 87.50% (35/40) resulted from total hip arthroplasty. The outcomes of the treatment according to Harris scoring criterion had statistical significance resulted from between conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, anatomical plate internal fixation and bipolar femoral placement, total hip arthroplasty (P < 0.05). The outcomes of the treatment had not statistical significance resulted from among conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P > 0.05). The outcomes of the treatment had no statistical significance resulted from between bipolar femoral placement and total hip arthroplasty (P > 0.05).

Adverse events

Three cases suffered from postoperative infections, and one patient died from concurrent cardiopulmonary failure 10 days after surgery.

参考文献

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引言

材料方法

Design

Comparative observation.

Time and setting

The study was completed in the Department of Orthopedics, Affiliated Hospital of Xiangnan University from January 2000 to January 2012.

Subjects

Totally 176 patients with osteoporotic hip fracture included 63 males and 113 females, with a mean age of (76.7±6.3) years (range from 65 to 95 years). Eighty-four cases suffered from interchanteric fracture, including 27 males and 57 females, with a mean age of (77.7±9.1) years (range from 66 to 95 years). All fractures in the cases of interchanteric fracture were divided according to Evans-Jensen classification standard, Ⅰ type in 11 cases, Ⅱ type in 25 cases, Ⅲ type in 38 cases, Ⅳ type in 10 cases. Seven cases were treated by conservative methods, 34 cases by dynamic hip screw, 18 cases by cannulated pull screw, seven cases by anatomical plate, 12 cases by artificial bipolar femoral head replacement and six cases by total hip replacement. Ninety-two cases suffered from femoral neck fracture, including 36 males and 56 females, with a mean age of (74.6±8.2) years (range from 65 to 92 years). All fractures in these 92 cases of femoral head fracture were divided according to Garden classification standard, Ⅰ type in 10 cases, Ⅱ type in 23 cases, Ⅲ type in 31 cases, and Ⅳ type in

28 cases. Forty cases were treated by artificial bipolar femoral head replacement, 37 cases by total hip replacement, and 15 cases by cannulated pull screw.

Inclusion criteria^[1-2]: (1) Patients all aged ≥65 years old; (2) bone marrow density value was less than or equal to 2.5 standard deviation of normal young values; (3) patients were hospitalized for hip fractures; (4) informed consent was obtained from patients who were approved by the hospital ethic committee.

Methods

Preoperative preparation

Related examinations were done for a comprehensive assessment of the patient’s body. Concomitant diseases were treated first, as well as infections. Fasting blood glucose was less than 8.0 mmol/L in diabetics, and patients with thrombocytopenia were given platelet drugs and transfusion of fresh platelets, and finally the number of platelets accounted for over 8.0×10¹⁰/L. Anemia patients were given drug therapy or transfusion of red blood cells to increase the hemoglobin level up to 100 g/L or more. Three days before operation, antibiotics were used. Under strict aseptic conditions, preoperative catheterization was performed.

Treatments

Of the 84 patients with interchanteric fracture, seven cases were treated by conservative methods, 34 cases by DHS, 18 cases by cannulated pull screw, seven cases by anatomical plate, 12 cases by artificial bipolar femoral head replacement and six cases by total hip replacement. Of the 92 patients with femoral neck fracture, 40 cases were treated by artificial bipolar femoral head replacement, 37 cases by total hip replacement, and 15 cases by cannulated pull screw.

Dynamic hip screw intervention

An incision was given from greater trochanter apex to the distal on lateral femur. Under the perspective of C-arm X-ray machine, the compression screw probe was inserted into the femoral neck, then the length was measured and the screw was implanted, and lateral plate was also implanted, the cortical screw was used to fix plate and femoral shaft. To prevent rotation deformity of femoral head, an anti-rotation screw was inserted into the top of the compression screw.

Cannulated screw and anatomical plate interventions

An incision was given from greater trochanter apex to the distal on lateral femoral proximal, followed by traction reduction. Under the perspective of C-arm X-ray machine, the collodiaphyseal angle was ensured as 130° and anteversion angle as 10°-15°: (1) Cannulated screw group, a parallel or“品”shaped probe was inserted at 2.0-3.0 cm below the greater trochanter apex, through the femoral neck, then a satisfactory position was achieved by C-arm X-ray and the length of screw was measured, 2-3 hollow screws were used for fixation. (2) Anatomical plate group, anatomical plate was inserted with the plate top screwed three cancellous bone screws and the plate bottom fixed by cortical screws and femoral shaft. Tensile screw was used to fix greater and lesser trochanter, as well as bone mass.

Bipolar femoral head replacement and total hip replacement interventions

An incision, 6-10 cm long, was performed at lateral hip, keeping gluteus medius muscle in the femoral trochanter top, removing femoral head and bone fragments at 1.0-1.5 cm of joint capsule away from lesser trochanter, protecting the bone fracture mass of the greater and lesser trochanter, temporary fixation with Kirschner wire was given for fracture reduction to achieve anatomic reduction: (1) Bipolar femoral head replacement: osteoporosis patients did not need forced reaming to prevent intraoperative femoral fractures, femoral pedicle with appropriate length was suggested, pedicle was 2-3 cm longer than distal fracture line, then fixed with bone cement in marrow cavity, the severely crushing bone mass of greater trochanter was tied using wire. (2) Total hip replacement group, acetabular bone sclerosis was wore off using burr and the surrounding inflammatory granulation tissues were cleared until the bone surface was fresh, other steps were same with bipolar femoral head replacement.

Postoperative management

Postoperative antibiotics were used to prevent infection and the drainage tube was removed within postoperative 24 hours to reduce retrograde infection. Prevention of deep vein thrombosis: the prevention of deep vein thrombosis twice per day was given using manual or cycle therapeutic apparatus, low molecular heparin anticoagulation to prevent thrombus. From postoperative 1 day, the patients were guided to do activities in bed, also informed of the limits of motion range. Hip joint activities were not allowed in patients undergoing hip fracture fixation; hip flexion should restrict to 90° within 6 weeks for patients with prosthetic replacement. The posterior prosthesis replacement patients were also required to forbid hip joint adduction and rotation within 6 weeks. A pillow under legs could keep affected limbs abduction. From postoperative 1 day, they exercised in an order of active aid→active→anti-resistance. Patients received prosthetic replacement were rechecked at

6 weeks postoperation and began weight-bearing activities with the aid of crutches, internal fixation patients were rechecked the photos at 8-12 weeks and began weight-bearing activities with crutches.

Anti-osteoporosis treatment after surgery

Vitamin D + calcium or Caltrate orally, a tablet per time, twice a day; salmon calcitonin 50 IU, subcutaneous injection, once a day; risedronate 5 mg daily between two meals, for 3 months.

Main outcome measures

Modified Harris hip function score was to evaluate treatment effects, including pain, function, deformity, activity^[3]: Total score was 100 points, 90-100 was excellent, 80-89 was good, 70-79 was fair, below 70 was poor.

Statistical analysis

Using SPSS 13.0 software, measurement data were expressed as mean ± SD. Intergroup comparison was done using t test. A level of P < 0.05 was considered statistically significant.

讨论

Osteoporotic hip fractures include pertrochanteric and femoral neck, subtrochanteric and diaphyseal hip fractures, mainly constituted by interchanteric fracture and femoral neck fracture. A vast amount of literature describes the incidence of fracture as a risk for recurrent osteoporotic fractures^[4]. A bone marrow density measurement was reported by 28.2% of patients, 51.5% were informed that they had osteoporosis, and 33.0% received prescription medications for osteoporosis^[5]. The overall incidence density of femoral neck in 2005-2010 was 124.8 new cases per 100 000 persons per year in a Spanish^[6].

Now, dynamic hip screw treatment has become a gold standard for treatment of intertrochanteric fracture. With its increasingly wide range of applications, minimally invasive surgical procedures are emerging in recent years^[7]. Dynamic hip screw is an extramedullary fixation system, requiring high integrity of the lateral cortex of the greater trochanter, and their plate was loaded in the lateral bearing line, any defects of medial cortical bone caused varus stress may add to internal fixation devices, leading to cut femoral head, broken junction between nails and plates, or screw sliding plate. As for osteoporosis patients with severe crushing, excessive compression may induce nail head piercing femoral head, internal fixation is always failed^[8]. In this paper, seven cases suffered from internal fixation cutting. Also there were some cases suffering from inward displacement of the distal femoral shaft resulted in limb shortening and varus deformity, which affect involved hip joint functions. The results in this paper showed that the rate of excellent and good of hip joint function in dynamic hip screw group at the follow up was 76.67% (23/30). In this study,

34 patients with osteoporotic fracture were treated with dynamic hip screw, Ⅰ+Ⅱ type (stable) in nine cases, Ⅲ+Ⅳ type (unstable) in 25 cases. And there were

30 cases being followed up. Harris score good rate was 76.67% (23/30) and there was no significant difference compared with femoral proximal anatomical plate (66.67%, P > 0.05), but was statistically significant with the joint replacement group (P < 0.05), the complication incidence was 46.67% (14/30) in dynamic hip screw group, showing no statistically significant difference with the proximal femur anatomical plate group(50.00%, P > 0.05). However, there was a statistical significance with bipolar femoral head replacement (23.40%, P < 0.01). Dynamic hip screw complications are mainly suitable for Evans-Jensen Ⅲ+Ⅳ type^[9]. With the increasing failure of dynamic hip screw for treatment of intertrochanteric fractures of aged patients, many scholars do not promote the use of dynamic hip screw for the unstable intertrochanteric fracture^[10-13]. They were preferable to locking compression plate because of low probability of nail breakage. The locking compression plate is more suggested for osteoporotic or unstable hip fracture in patients^[14].

Proximal femoral anatomical plate, similar with dynamic hip screw, is extramedullary fixation system. Proximal femoral anatomical plate includes steel plate and many common screws designed according to the lateral anatomical plate^[15-16]. The integrity of outer cortex of the greater trochanter does not require more as dynamic hip screw. But any defects of medial cortical bone easily lead to increase varus incidence^[17-18]. Poor anti-strength of osteoporotic fracture screws cannot achieve firm fixation, easily causes internal fixation loosening and limb shorten^[19-20]. The results of this study showed that six osteoporotic intertrochanteric fracture patients treated by proximal femoral anatomic plate only account for only a small quantity of hip fractures, Harris score rate was 66.67% and complication rate was up to 50.00%, of which internal fixation cutting in one case, avascular necrosis of femoral head in one case, delayed fracture healing in one case. The result suggests the proximal femoral anatomical plate is not very suitable for treatment of elderly osteoporotic intertrochanteric fractures. Whether to choose bipolar femoral placement or hip joint replacement therapy in the treatment of intertrochanteric fractures are controversial^[21-22]. The opponents argue that femoral intertrochanteric basilar part is rich in blood supply, contributing to a rapid fracture healing and few nonunion and non-healing of internal fixation^[23-24]. But to the unstable intertrochanteric fractures in elderly patients, the patient underwent artificial femoral head replacement can get out of bed and load at early stage, while intertrochanteric prosthesis can fix greater trochanter which is different to dynamic hip screw and proximal femoral nail fixation system to fix, reduce postoperative pain, correspondingly increase muscle contraction, decrease venous thrombosis. so showing the advantages of artificial joint replacement in the treatment of unstable intertrochanteric fractures in elderly patients. Now many researchers support the use of artificial joint replacement for treatment of unstable intertrochanter fracture^[25-26]. There were 12 cases treated by bipolar femoral replacement and six cases by total hip arthroplasty in this study. The results were satisfactory. The patients could early bear weight with no pain. The greatest advantage of artificial joint replacement is a low complication, also it is an effective remedy treatment for intertrochanteric fracture internal fixation failure^[27-28]. Bone cemented bipolar femoral head replacement and new metal wire cerclage were applied in the treatment of elderly patients with unstable osteoporotic intertrochanteric fracture. The greater trochanter has a very important anatomical and biomechanical significance. Firm fixation of the greater trochanter could significantly reduce postoperative pain and prevent the femoral pedicle loose. Bipolar femoral head replacement should select patients with average age > 70 years old, unstable osteoporotic fractures of Jensen Ⅱ-Ⅲ type^[29-30]. Greater and less trochanter fragments should be protected during surgery as far as possible to achieve anatomical reduction, severely comminuted greater trochanter is suggested to be firmly fixed using a wire, protecting the greater trochanter fascia. Severe osteoporotic patients should be given gentle movements.

The treatment of femoral neck fracture was mode up internal fixation and joint replacement The traditional fixation was cannulated screw fixation. Cannulated screw fixation could achieve satisfactory effect for the hip femoral neck fractures without intracapsular displacement. But the internal fixation has a high failure rate in aged osteoporotic femoral neck fractures^[30-31].

In this study, bipolar femoral replacement or total hip arthroplasty are the optimal choice for aged femoral neck fracture with osteoporosis Garden Ⅱ, Ⅲ, Ⅳ type. GardenⅠtype is suitable to cannulated screw fixation. The complications incidence of cannulated screw fixation was 53.13%. The rate of excellent and good in Harris score was 71.88%. Therefor, it can lead to fracture displacement and a higher probability of avascular necrosis, and more other complications femoral neck fracture of Garden Ⅱ, Ⅲ, Ⅳ type in elderly osteoporotic patient underwent cannulated screw fixation. And it also bring patients great psychological and economic burden to the patients. The bipolar femoral replacement or total hip arthroplasty can contribute to early activity in patients, reduce bedding time, early bearing action so to reduce long-term mortality, prevent nonunion, avascular necrosis and articular surface collapse. Bilateral femoral head replacement is suggested for osteoporosis patients with short life expectancy, it can reduce hip varus, acetabular wear and pain. Total hip replacement is usually applied for the most unstable osteoporotic femoral neck fracture. In this study, cannulated screws and bipolar femoral replacement or total hip arthroplasty were used in the treatment of osteoporotic femoral neck fractures in the aged patients, result showed low complication rates, early activities, and good joint function of joint placement, thus joint placement becomes the optimal choice for the treatment of osteoporotic femoral neck fracture of Garden Ⅱ, Ⅲ, Ⅳ fractures.

老年骨质疏松性髋部骨折的优化治疗方案

Optimized surgical treatment for osteoporotic hip fractures in the elderly

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