三种术式治疗老年股骨粗隆间骨折

Three Different Surgical Methods in the Treatment of the Femoral Intertrochanter Fracture of the Elderly

目的:探讨老年人股骨粗隆间骨折不同手术方式的选择。方法:我院2004年1月至2007年12月间应用不同术式治疗老年股骨粗隆间骨折110例,其中动力髋螺钉(DHS)25例,股骨近端髓内钉(PFN)41例,人工股骨头置换44例。术后所有患者均获随访,平均12.6个月。对术后并发症和按照Kuderna改良Merli DAubigne标准得到的髋关节功能恢复优良数(率)进行评价。结果:术后出现并发症3例,其中PFN术式2例;人工股骨头置换术式1例。围手术期内无伤口感染.无死亡病例。三种术式总体优良数(率)为:107(97.3%)。结论:三种手术方式各有其优缺点,没有一种术式能普遍适用于各种类型粗隆间骨折,临床上,为了最大限度降低手术风险,我们没有必要专注或偏好于某一种手术方式,要根据患者的个体差异及每种术式的优缺点,灵活地为每例股骨粗隆间骨折患者制定出其最适宜的手术方式,大都能取得满意的疗效。

Objective：To investigate the chosen of 3 different surgical methods in the treatment of intertrochanteric femoral fractures in the elderly.Methods：From January,2004 to December,2007,110 cases with the femoral intertrochanteric fractures in the elderly were treated with the followed 3 kinds of operations respectively：dynamic hip screw（25 cases）,proximal femoral nail（41 cases）,hip hemiarthroplasty（44 cases）.After surgery all patients were followed up;Followed-up period range from 6 months to 18 months（average 12.6 months）.The good and excellent number（rate） of 3 surgical methods with Merli D＇Aubigne evaluation criteria were evaluated,and compared in the postoperative complications.Results：3 complications occurred postoperatively（2 with PFN,1 with hip hemiarthroplasty）, none wound infection or died in Perioperatie.The total good successful number（rate） was 107（97.3%）. Conclusion：Each has its advantages and its disadvantages.None of three kinds of surgical methods can be used generally all kinds of the femoral intertrochanter fracture.In clinical work,we don not need to focus on or prefer to the only one of them in order to minimize the risk.The good response to treatment will be get if we can choose the appropriate method according to the individual differences of the advantages and disadvantages of each method.