高龄股骨粗隆间骨不连原因分析与治疗

Ununion Senile Intertrochanter Fracture of Femur:An analysis on causes and treatment

目的探讨高龄股骨粗隆间骨不连的形成原因和治疗方法。方法14例高龄股骨粗隆间骨不连患者根据Singh股骨近端机械强度分级标准酌情选择内固定或半髋置换方案。结果术后随访6～24个月,平均15.2个月,粗隆间骨不连治愈,患髋功能按Sanders髋关节功能评分标准,优良率达92.9,患肢能满足日常生活需要,术后未并发髋内翻畸形。结论骨折端不良应力是导致股骨粗隆间骨不连的主要原因。治疗时应视伤肢骨质条件,酌情实施手术方案,对骨机械强度差的严重骨质疏松的老龄患者因将提高生活质量作为治疗目标,应选择能尽早实现直立行走的半髋置换治疗方案。

Objective To explore the causes and relative treatment of ununion senile intertrochanter fracture of femur. Methods 14 cases of senile intertrochanter fracture of femur were treated by internal fixation or semi - hip replacement according to the Singh index. Results All patients were followed up for 6 - 24 months （ with a mean of 15.2 months）, during which all fractures were reunited. The postoperational function of hip was assessed with Sander＇s criteria while the excellent rate is 92.8%. No varus malformation was occurred among these patients and all of them have the ability to live in a normal life. Conclusion The abnormal stress between fragments of fractures is the main cause for this kind of ununion. The choice of treatment should be decided by bone mass and the general condition of patients. The semi - hip replacement may be the first choice for patients with severe osteoporosis and bad general condition in order to shorten the recovery period in bed.