脳血管障害後に発生した大腿骨頚部骨折の治療成績

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タイトル別名
  • Clinical Results of Femoral Neck Fractures of Patients with Cerebrovascular Diseases.
  • ノウケッカン ショウガイ ゴ ニ ハッセイ シタ ダイタイコツ ケイブ コッセ

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We studied the results of various surgical treatments for femoral neck fractures. The results were measured mainly by comparing postrehabilitation walking ability with pretrauma walking ability. There were 56 patients in the study, covering the time period Nov. 1988 to Nov. 1996. All patients were 60 or more years of age and had a history of cerebrovascular disorders. 30 patients (54%) regained their pretrauma walking ability. Very old patients (85 and over) and patients with dementia had a poor rate of regaining their pretrauma walking ability. Hemiparesis did not influence the results for patients with affected side fractures but result were reduced for patients with non-affected side fractures. Bipolar arthroplasty produced excellent results for patients with medial type fractures of the Garden classification type III/IV. The prompt firm fixation at the fracture site allows the patient to rise from bed and start weight bearing in the shortest postoperative span. Ender pin fixation produced poor results for patients with unstable lateral type fractures. The lack of firm fixation after surgery causes patients to spend lengthy time in bed and delay the start of weight bearing. The lengthy time in bed contributes to worsening or development of dementia. Our conclusion is that bipolar arthroplasty is more suitable than the Ender pin method for unstable type of fractures with difficulty of reposition.

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