老年人股骨粗隆部骨折的术式选择

Selection of operative methods for femoral intertrochanteric fractures in aged patients

目的探讨老年人骨质疏松性股骨粗隆部骨折的内固定方法选择原则。方法对68例老年人不稳定型股骨粗隆部骨折在C臂X光机监视下手法复位后,根据Evans分型及全身健康状况应用不同的内固定治疗,其中动力髋螺钉(DHS)38例、动力髁螺钉(DCS)25例、外固定支架5例。结果68例均获得6个月以上随访,平均随访18.2个月,按Harris评分标准,优良率88.2%。结论根据Evans分型及全身健康状况选择不同的内固定手术,可以提高老年人不稳定型股骨粗隆部骨折的疗效。

[Objective] To explore the operative method of internal and external fixation in aged patients with osteoporotic femoral intertrochanteric fractures. [Method] 68 cases of osteoporotic intertrochanteric fractures aging from 60 to 101 years with average of 76, were treated with internal and external fixation. According to Evans classification system, 38 type I cases were fixed with DHS, 5 type Ⅰ cases were fixed with external fixator, 25 typeⅡcases were fixed with DCS. [Results] All the 68 patients were followed-up for 18.2 months in average （range 6-35m）, 88.2% were classified as exceUent and good in Harris score. [Conclusions] Evans classification system is helpful for selecting operative method. If the fixation devices are reasonably used according to the type of fractures and severity of osteoporosis, the effects of treatment of osteoporotic femoral intertrochanteric fractures can be improved.