老年股骨粗隆间骨折治疗方法探讨

TREATMENTS OF GERIATRIC FEMORAL INTERTROCHANTERIC FRACTURES

目的总结老年股骨粗隆间骨折的治疗方法及效果。方法2005年1月-2007年12月,收治192例老年股骨粗隆间骨折患者。其中男85例,女107例;年龄65～92岁,平均75岁。致伤原因:走路跌伤106例,骑车摔伤55例,交通事故伤31例。骨折按Evans分型,ⅠA型12例,ⅠB型43例,Ⅱ型29例,ⅢA型24例,ⅢB型23例,Ⅳ型26例,Ⅴ型35例。合并心脑血管疾病150例,高血压120例,慢性支气管炎90例,糖尿病75例。受伤至入院时间1h～14d。其中保守治疗108例,动力髋螺钉(dynamic hip screw,DHS)固定68例,股骨近端髓内钉(Gamma钉)固定16例。结果患者均获随访,随访时间12～36个月,平均18个月。骨折均达骨性愈合,无延迟愈合及不愈合。保守治疗组平均住院时间48d,骨折平均愈合时间14周,发生不同程度髋内翻23例,髋关节功能按Harris评分标准进行评价,优45例,良31例,可10例,差22例,优良率为70.4%。DHS内固定组平均手术时间60min,平均术中出血量200mL,平均住院时间24d,骨折平均愈合时间12周,患髋功能按Harris评分标准进行评价,优38例,良21例,可8例,差1例,优良率86.8%。Gamma钉固定组平均手术时间70min,平均术中出血量200mL,平均住院时间14d,骨折平均愈合时间12周,患髋功能按Harris评分标准进行评价,优11例,良4例,可1例,优良率93.8%。结论对老年股骨粗隆间骨折,应积极手术治疗,充分术前准备,根据患者健康状况及骨折类型选择合适的个体化治疗方法。

Objective To investigate the treatment method of senile patients with femoral intertrochanteric fractures and its clinical outcomes. Methods From January 2005 to December 2007,192 senile patients with femoral intertrochanteric fractures were treated,including 85 males and 107 females aged 65-92 years old （average 75 years old）. The injury was caused by fall on walking in 106 cases,fall when riding a bicycle in 55 cases,and traffi c accidents in 31 cases. According to Evans classifi cation,there were 12 cases of type Ⅰ A,43 cases of type I B,29 cases of type Ⅱ,24 cases of type Ⅲ A,23 cases of type Ⅲ B,26 cases of type IV,and 35 cases of type V. One hundred and fifty patients were associated with cardio-cerebrovascular diseases,120 patients were complicated with chronicle hypertension,90 cases were associated with bronchitis,and 75 cases were complicated with diabetes. The time from injury to hospital admission was 1 hour to 14 days. Among those patients,108 were treated with conservative treatment,68 received dynamic hip screw （DHS） fi xation,and 16 underwent proximal femoral Gamma nail fixation. Results All the patients were followed up for 12-36 months （average 18 months）. The fracture all reached bone union without occurrence of nonunion and delayed union. Patients could take care of themselves,and there were no occurrences of serious pains and dysfunctions. The therapeutic effect was satisfactory. The conservative treatment group：the average hospital stay length was 48 days; the average bone healing time was 14 weeks; 23 cases had different degrees of coxa adducta; Harris score system was adopted to evaluate hip joint function,45 cases were graded as excellent,31 as good,10 as fair,and 22 as poor,and the excellent and good rate was 70.4%. DHS internal fixation group：the average operation time was 60 minutes; the average bleeding volume during operation was 200 mL,the average hospital stay length was 24 days; the average bone healing time after operation was 12 weeks; Harris score system was adopted to evaluate the injured hip joint function,38 cases were graded as excellent,21 as good,8 as fair,and 1 as poor,and the excellent and good rate was 86.8%. Gamma nail fixation group：the average operation time was 70 minutes; the average bleeding volume during operation was 200 mL,the average hospital stay length was 14 days; the average bone healing time after operation was 12 weeks; Harris score system was adopted to evaluate the injured hip joint function,11 cases were graded as excellent,4 as good,1 as fair,and the excellent and good rate was 93.8%. Conclusion For geriatric femoral intertrochanteric fractures,operative treatment should be performed,the preoperative preparation should be sufficient,and individual-oriented treatment method should be selected on the basis of physical conditions of patients and the types of fractures.