老年患者不稳定性股骨转子间骨折的术式选择

Selection of operative methods for unstable intertrochanteric femoral fractures in aged patients

目的探讨不同的内固定方式在老年患者不稳定性股骨转子间骨折治疗中的应用。方法参照Evans分型,85例老年患者股骨转子间骨折,不稳定性77例,稳定性8例,分别应用不同内固定治疗,其中Gamma钉20例、重建钉25例、动力髋部螺钉(DHS)和动力髁部螺钉(DCS)40例。结果术后随访79例,均获得骨折愈合,愈合时间4～7个月,平均5.2个月,其中大于5°髋内翻者有12例。根据患者骨折愈合、关节活动、主观感觉与生活能力恢复等因素制定疗效评定标准,优良率为84.8%(67例)。未发生因本手术所致内科合并症加重或患者死亡。结论髋内翻是老年患者不稳定性股骨转子间骨折内固定术后的主要并发症。Evans分型对选择内固定具有指导意义。结合老年患者骨质疏松情况,针对不同骨折类型选用适当的内固定器械,可以提高不稳定性转子间骨折的疗效。

Objective To explore various internal fixation devices in the treatment of unstable intertrochanteric femoral fractures in aged patients. Methods 85 aged patients with intertrochanteric femoral fractures were treated in our department from January 1997 to October 2002. According to Evans classification system, there were 8 stable ones and 77 unstable ones. 20 cases were fixed with Gamma nails, 25 with reconstruction intramedullary nails, 40 with Dynamic HIP Screw(DHS) and Dynamic Condylar Screw(DCS). Results 79 cases were followed up and all achieved fracture healing at 4 to 7 months (averaging 5.2 months) after operation. Coxa varus of 5 degrees or above appeared in 12 cases. The treatment effects were evaluated in terms of fracture healing, joint motion, subjective feeling and daily living ability. Excellent and good results were achieved in 67 cases (84.8%). No associated complications got worse and no patient died because of operation. Conclusions Coxa varus is the main complication of unstable intertrochanteric femoral fracture in aged patient after internal fixation. Evans classification system can help surgeons select operative methods. If internal fixation devices are reasonably used in accordance with the type of fracture and severity of osteoporosis, the effects of treatment of unstable intertrochanteric femoral fractures can be improved.