高齢者の大腿骨頚部内側骨折に対するAustin-Moore人工骨頭の有用性

The Advantage of an Austin-Moore Hemiarthroplasty for the Femoral Neck Fractures in the Elderly

　抄録：医療費の高騰が社会全体の問題となっているが，低侵襲・低コストなAustin-Moore人工骨頭の有用性を検討した．対象は当院で大腿骨頚部内側骨折と診断し人工骨頭置換術を施行した患者で経過観察が可能であった8例で，性別は男1例，女7例，平均年齢83.9歳であった．方法は，1．除痛・歩行能力，2．手術時間，3．出血量，4．入院期間，5，医療費，6．手術合併症について調査した．2～5の項目については，同時期に施行したバイポーラー人工骨頭置換術群と比較した．結果は，Austin-Moore人工骨頭の8例は受傷前とほぼ同等のADLを獲得しており，除痛も良好に得られていた．手術時間，術中出血量はバイポーラー群に比べ有意に少なく，医療費はインプラント代が約1/8，入院費も60万円安であった．

　1．高齢者大腿骨頚部内側骨折に対するAustin-Moore人工骨頭の有用性を検討した．

　2．Austin-Moore人工骨頭は低侵襲・低コストであった．

　3．高齢者および受傷前から歩行能力が低い症例に対して，Austin-Moore人工骨頭は有用であると考えた．

　Since the increase of medical cost has been a social issue, the economic impact and the patient's activity of an Austin-Moore hemiarthroplasty were retrospectively assessed in the treatment of the femoral neck fractures. We evaluated eight patients who had been diagnosed the Garden stage Ⅲ or Ⅳ femoral neck fracture and received an Austin-Moore hemiarthroplasty. There were one male and seven females. The average age at the surgery was 83.9 years. The control group was consisted of patients who underwent bipolar hemiarthroplasty after the same type fracture, during the same serial periods. Pain and activity, operative time, total blood loss, hospitalized periods, total medical cost, and surgical complications of the Austin-Moore group were compared with those of the control group. The activity of daily life in the Austin-Moore group was almost same as that of preinjury state. They had no pain at the time of final evaluation. There was significantly shorter operative time and less total blood loss than those in the control group. The significant difference was observed in the mean of total medical cost, 600,000 JPY cheaper than the control group. The price of the Austin-Moore prosthesis was one eighth of the bipolar device. Although medial calcar crack was occurred in two of fours patients who had a regular sized Auntin-Moore femoral stem, they had no symptornatic problems during the follow-up period.

　Conclusions：

　1．We evaluated the economic impact and the patient's activity of an Austin-Moore hemiarthroplasty as the treatment of the intracapsular femoral neck fracture in the elderly.

　2．Total medical cost was significantly low in the Austin-Moore group comparing to the control group.

　3．Surgeons who are dealing with hip fractures should select adequate implants considering patient's age, demands, and functional outcomes