高龄患者股骨粗隆间骨折内固定治疗选择

Treatment Options for Intertrochanteric Femoral Fracture by Internal Fixation in the Elderly

目的:探讨高龄股骨粗隆间骨折的内固定治疗方法。方法:对本院2000-2003年84例高龄患者股骨粗隆间骨折回顾性分析。所有病例均行术前X线分析,选择内固定治疗方法,复杂型要同时准备三套内固定系统,尽可能早期经髋关节外侧切口选择性行DHS或LAP或PFN内固定术。术前处理好内科合并症,应用抗生素。术后按计划开始患髋关节及同侧膝关节的持续被动功能锻炼(CPM)和主动运动。结果:优42例,良35例,差7例,关节功能优良率91.6%,所有病例骨折愈合平均8周,关节功能恢复良好。结论:选择性应用DHS、LAP、PFN内固定治疗各种类型高龄股骨粗隆间骨折,疗效可靠,并发症少,是老年股骨粗隆间骨折理想的治疗方法。

Objective:To study the treatment options for intertrochanteric femoral fracture by internal fracture. Methods: eighty-four cases of intertrochanteric femoral fracture admitted in our hospital during 2000 to 2003 were reviewed. All the cases were evaluated by X-ray prior to operation for selection of internal fixation options. For complicated fractures, 3 different systems of internal fixation, eg. Dynamic hip screw (DHS), proximal femoral nail (PFN) and L-angled Plate (L-AP) were prepared for selection at time of operation that was scheduled as early as possible. Comorbidities were controlled and antibiotics administered before surgery. After operation, the patients were required on active and passive functional exercises to the affected hip joint and ipsilateral knee joint. Results: The treatment outcomes were excellent in 42 cases, good in 35 and bad in 7, with the rate of effectiveness being 91.6%. All the fractures healed over a mean time of 8 weeks, with well-recovered joint functions. Conclusion: Proper selection of DHS, L-AP and PFN is effective for treatment of intertrochanteric femoral fracture in the elderly, with few complications.