老年不稳定型转子间骨折的内固定选择及术后并发症原因分析

Internal fixation of unstable intertrochanteric fractures and post-op erative complications in elderly patients

目的探讨不稳定型老年转子间骨折的内固定方法选择及术后发生并发症的原因。方法对手术治疗的65例不稳定型老年转子间骨折进行回顾分析。结果65例随访12～82个月(平均36.2个月),优良率81.5%。并发症主要为髋内翻畸形5例、内固定松动断裂3例和术后诱发原有合并症2例。结论对于老年不稳定转子间骨折的治疗,应针对不同的骨折类型,以及患者的全身状况,选择最适合的内固定,主要选用股骨近端交锁髓内钉(PFN)和动力性髋部钉(DHS),外固定架和多枚钉固定不宜采用。

Objective To discuss how to select proper internal fixation devices for unstable in tertrochanteric fractures in the elderly and analyze the causes of post-operative complications.Methods To retrospectively review a series of 65patients treated with i nternal fixation using contemporary techniques for unstable intertrochanteric frac-tures between March 1995and October2002in our department.Results The average follow-up was 36.2month s(range:12to 82months).Excellent and good functional resu lts were obtained in 53patients(81.5%).The main complications were varus malunion(5cases),failure of internal fixation(3cases)and eliciting pre-existing disease s(2cases).Conclusions In order to reduce the mortality and morbidity and improve functional end results,the un-stable intertrochanteric fracture in the elderly should be treated by early operation and use of internal fix ation appara-tus.One of the most important factors in this regard is selection of a prop er fixation device according to fracture type and physical status of the specific p atient.Proximal femoral nail or dyn amic hip screw is the choice of treatm ent for such fractures.External fixation a nd multiple screws or pins are not recommended.An anatomic reduction,im plant placement in the biomechanically id eal position and well-scheduled reh abilitation program are also important for ex-cellent functional results.[