微创动力髋螺钉治疗高龄股骨转子间骨折

Treatment of intertrochanteric fractures with minimally invasive dynamic hip screws in the elderly

目的探讨微创动力髋螺钉(DHS)固定治疗高龄股骨转子间骨折的临床效果. 方法 1999年1月-2004年5月,采用闭合复位、小切口DHS固定治疗85例高龄股骨转子间骨折,其中男31例,女54例;年龄65～99岁,平均75.3岁. 结果手术中平均出血量50 ml,术后平均引流量6 ml,术前、术后血红蛋白值比较无明显变化;85例均获1～4年随访,无死亡病例.骨折愈合时间8～11周.髋内翻2例,旋转畸形2例,无伤口感染、内固定失效及延迟愈合.关节功能优75例,良6例,可4例,优良率95.3%. 1年后生活自理能力恢复到受伤前水平58例(68%), 有影响25例(29%),明显影响2例(2%). 结论手术是治疗高龄股骨转子间骨折的有效办法,采用创伤小、恢复好、并发症少的微创DHS内固定技术,可进一步提高患者的生存率和生活质量.

Objective To evaluate the result of minimally invasive dynamic hip screws （MIDHS） in treatment of intertrochanteric fractures in the elderly. Methods A total of 85 old cases （31 males and 54 females, at age range from 65 years to 99 years, mean 75.3 years） with intertrochanteric fractures were treated with closed reduction and MIDHS in our hospital from January 1999 to May 2004. Results The mean amount of blood loss in operation and mean postoperative drainage volume were 50 ml and 6 ml respectively. The mean amount of hemoglobin showed no significant difference between preoperation and post operation. A follow up for 1-4 years showed no death. The clinical bone healing lasted for 8-11 weeks. The complication included varus deformity of hip in two cases, and lower extremity rotatory deformity in two, with no incision infection, fixation failure or delayed union. The excellent hip function results were reported in 75 cases, good in six and fair in four, with excellence rate of 95.3%. Physical status was completely recovered to normal in 58 cases （68%） , resulted in partial loss in 25 （29%） and disabled in two （2%）. Conclusions MIDHS, characterized by little trauma, good recovery and less complications, is a effective method for intertrochanteric fractures and can further improve survival rate and life quality in the elderly cases.