老年股骨粗隆间骨折的内固定治疗及并发症分析和手术危险性预测

Complications and high-risk factors of internal fixation in elderly patients with intertrochanteric femoral fracture

目的:比较不同内固定方法治疗老年股骨粗隆间骨折的疗效,并发症发生原因并预测手术危险的高危因素. 方法:1995-03/2001-06收治60岁以上老年股骨粗隆间骨折患者168例. 行手术内固定治疗136例,83例获得12～75(平均37.8) mo的随访,通过病历分析获得年龄、性别、骨折类型、手术方式、手术时间、住院天数、术中出血量、是否输血以及输血量、伤前生活自理能力、伤前身体状况、术前血红蛋白(Hb)水平、功能恢复及并发症发生情况,分别按手术方式、骨折类型以及年龄分组比较其疗效和并发症发生情况,通过计算发生并发症(尤其是术后早期并发症)患者的平均年龄和手术危险性预测综合指数W值,预测手术危险的高危因素. 结果:本组83例,术后功能恢复优良67例,可9例,差7例;优良率80.7%. 术后发生并发症10例,平均年龄为82岁,发生率12.0%,术后早期诱发原有合并症3例,平均年龄为92岁. 动力髋内固定组的手术时间比其他两组明显延长(P＜0.05);术中出血以及输血量比其他两组明显增多;髓内钉内固定组住院天数比其他两组明显缩短;年龄大于70岁组功能恢复较差;以上比较均有统计学意义. 各组并发症发生比较无显著性差异. 早期诱发原有合并症的3例患者,手术危险性预测综合指数W值分别为6, 7和8. 结论:老年股骨粗隆间骨折应合理选择内固定方式,DHS、髓内钉、多枚钉可满足各种不同类型和年龄的骨折,尤其是髓内钉适用范围较广;年龄可能是老年股骨粗隆间骨折手术危险的高危因素.

AIM： To compare the postoperative functional restoration and complication incidence of different therapies in elderly patients with intertrochanteric femoral fracture and to predict the high-risk factors of the operation. METHODS： One hundred and sixty-eight cases of elderly patients with intertrochanteric femoral fractures, who were treated from March, 1995 to June, 2001 were enrolled in the study. Of all the cases, 136 cases received internal fixation therapy and 83 cases were followed up for an average of 37. 8 months. According to operative approach, types of fractures and age, the patients were divided into several groups and the therapeutic effects and complications were compared. By calculating composite exponent W of operation risks and mean ages of patients with complications （especially at early stage after operation）, the prediction of the operation risk was made. RESULTS： Of the 83 cases, 67 （80. 7%） had good functional restoration. Of the 10 （ 12, 0% ） cases with complications after operation, 3 cases suffered complications at early stage after operation. The duration and bleeding volume of operation in dynamic hip screw （DHS） internal fixation group were more than those in the other groups （P〈0.05）. Hospitalization time in intramedullary pin internal fixation group was shorter than that in the other groups. Patients in the group of ages above 70 years had a bad functional restoration. Complication incidence between every two groups had no statistical significance. The average age in the 10 cases with complications was 82 years old. The mean age of 3 cases with early complications was 92 years old, whose exponent W was 6, 7 and 8 respectively. CONCLUSION. Suitable internal fixation materials should be chosen in the therapy of elderly patients with intertrochanteric femoral fractures. DHS, multipin, especially intrameduUary pin, can satisfy the needs of fractures of various types for all ages. Age may be a high risk factor in the therapy of elderly patients with intertrochanteric femoral fracture.