高龄患者股骨粗隆间骨折的外科治疗

Surgical treatment of elderly patients with intertrochanteric fracture

目的探讨高龄患者股骨粗隆间骨折外科手术治疗方法.方法 24例采用国产加压滑动鹅头钉固定,53例A1、A2型骨折采用动力髋螺钉(DHS)固定,16例A3型及部分A2型骨折采用股骨近端髓内针(PFN)固定,13例伴严重心肺功能不全者采用3枚中空拉力螺钉固定.结果本组住院12～21d,平均15.4d,住院期间出现4例肺部感染、2例切口浅表感染,短期短期内均获治愈.2个月内全部病例均获随访,未见内固定物松动及骨折部畸形.2～24个月随访,全部骨折均愈合,功能优良率为97.4%,未见髋内翻,股骨头缺血性坏死等并发症.结论高龄患者的股骨粗隆间骨折应尽可能采用外科手术治疗,避免合并症加重.在手术内固定方式的选择上,应综合分析骨折类型、患者的一般情况及内植物的固定特点,并根据术者的操作熟练程度恰当选择.

Objective To investigate the clinical results of the surgical treatment of elderly patients with intertrochanteric fracture.Methods One hundred-six cases of intertrochanteric fracture patients over 65 years old included 24 males and 82 females,admitted from January 1995 to June 2002,were treated with inplant surgery.The classfication included 30 cases of type A1,63 cases of type A2 and 13 cases of type A3.Twenty-four cases were fixed with slidind screw plate,53 cases fixed with dynamic hip screw,16 cases with proximal femour nail and 13 case with serious disorder of heart and lung were fixed with hollow nail.Results For all patients,4 cases got respiratory system infection,and 2 cases got incision infection.Average time stayed in hospital was 15.4d(12 - 21d).During follow-up period,no inplant failure and deformation were found post-operation at 2 month late,all the fractures were cured well from 2 to 24 months post operation,and the functional recovery of hip joint was satisfatory.Conclusion Uhe surgical treatment of elderly patients with intertrochanteric fracture is supported,it maybe reduced the complication and accelerated the bone healing.