Gamma钉治疗80股骨转子间骨折岁以上患者

Gamma nail for treatment of intertrochanteric fractures in the elderly patients aged 80 years and over

目的探讨80岁以上患者股骨转子间骨折手术的安全性，评价Gamma钉治疗这种复杂骨折的疗效。方法对31例80岁以上转子间骨折患者进行回顾性分析，统计术中和术后并发症、术后定期拍X线平片、髋关节Harris评分并调查患者的活动状态。结果31例患者平均年龄82．9岁，有并存症的患者占74．2％，均使用Gamma钉固定。平均随访22．5个月（6～33个月），所有骨折临床和影像学上均达到愈合；平均手术时间92．6min，平均失血量205ml，平均输血量387ml。术后髋关节Harris评分平均69分，1例因髋部疼痛较重在骨折愈合后取出内固定物；无股骨头坏死和深静脉血栓形成，无内固定物断裂及假体周围再骨折，术后只有10例患者恢复到骨折前的活动水平。随访期间共有5例患者死亡，死因均为内科疾病。结论Gamma钉对老年人转子间骨折的疗效较好，可部分恢复其骨折前生活质量，经过术前精细准备是一种相对安全、疗效满意的治疗方法，但老年人术后活动量仍趋减少，对社会依赖程度增加。

Objective To investigate the safety of surgical intervention for geriatric intertrochanteric fractures and evaluate the efficacy of Gamma nail for treatment of the complicated fractures. Methods Thirty one patients aged 80 years and over, treated for intertrochanteric fractures with Gamma nail were retrospectively reviewed. Perioperative complications, regular roentgenograms and evaluation of the operated hip function （Harris score） as well as mobility status were analyzed. Results The average age of these patients was 82.9 years and 74.2% patients were associated with comorbidities. All fractures were radiographically and clinically healed uneventfully with a median follow-up of 22.5 months （range 6-33 months）. The average operation time was 92.6 rain with an average lost blood of 205 ml and average transfused blood of 387 ml. The mean Harris score was 69. One insert was removed for severe pain in one patient after fracture union. No femoral head necrosis and no deep venous thrombosis were found. No hardware failure or periprosthetic fracture occurred. Only 10 patients were rehabilitated to pre-injury mobility status. Five patients died during the follow-up period and all were due to comorbidities. Conclusions The Gamma nail can provide an effective method of treatment for intertrochanteric fractures in elderly patients, partially restoring their preoperative quality of life. Through meticulous presurgical preparation, Gamma nail is a relatively safe method with a satisfactory clinical outcome. However, there is reduction in mobility among survivors and an increased level of social dependence.