高龄股骨转子间骨折的手术治疗

Operative treatment of intertrochanteric fractures in the elderly

目的分析80岁以上股骨转子间骨折患者的特点、手术适应证、并发症及治疗效果。方法统计手术治疗的80岁以上股骨转子间骨折患者87例(90髋),对骨折类型、术前原发病、手术方法、术后并发症等方面进行分析。结果本组患者平均83.5岁。其中74例患有不同种类和不同程度的内科疾病,平均每例患病2.4种。骨折固定方法有动力髋螺钉和髓内固定。术后6个月63例获得随访,功能评定优良率为84%(53/63)。结论高龄股骨转子间骨折的发病率高、术前疾病多,充分评估及治疗术前疾病是手术成功的前提。

Objective To analyze the fracture characteristics, operative indicators, complications and treatment results of intertrochanteric fractures of femur in over 80 years old cases. Methods A total of 87 cases （90 hips） of intertrochanteric fractures with mean age over 80 years treated with operative methods from October 1996 to October 2004 were reviewed upon fracture types, preoperative primary diseases, operative methods and postoperative complications. Results The average age was 83. 5 years. Of all, 74 cases had different physical diseases included cardiovascular, cerebrovascular, respiratory, digestive system and others （average 2.4 diseases per person）. Treatment methods included DHS and intramedullary interlocking nail such as Gamma nail, PFN and reconstructive nails. A follow up for six months in 63 cases showed that excellence rate of functional evaluation was 84% （ 53/63 ）. Conclusions The full evaluation and treatment of preoperative diseases are the prerequisite for the intertrochanteric fractures in the elderly, for the intertrochanteric fractures in the elderly have high incidence and many preoperative diseases and severe complications.