高龄患者股骨转子间骨折手术治疗的临床分析

Clinical efficacy analysis for the treatment of intertrochanteric fractures in elderly patients

目的 分析不同手术治疗高龄患者股骨转子间骨折的临床疗效.方法 手术治疗高龄股骨转子间骨折患者108例,男48例,女60例,年龄70～90岁,平均76.8岁.其中行DCS治疗16例,DHS 36例,Gamma钉12例,PFN 24例,髋关节置换20例.术后随访6个月～5年,平均3.1年.结果 术后疗效根据Harris髋关节评分,DCS优良率为81.3%,DHS优良率为91.7%,Gamma钉为 83.3% ,PFN优良率为95.8 % ,髋关节置换为100% .结论 双极长柄人工股骨头置换术治疗股骨转子间骨折在卧床时间,术后并发症发生率比内固定组少,关节优良率高,疗效好,尤其是对于粉碎性骨折合并严重骨质疏松患者,疗效比内固定组好.各种内固定方式治疗转子间骨折可获得良好疗效,但需掌握其适应症.PFN手术固定术中出血量比其他组少.

Objective Analysis of different surgical treatment in elderly patients with intertrochanterie fractures. Methods Surgical treatment of elderly patients with intertrochanteric fractures of 108 eases, 48 males and 60 females, aged from 70 to 90 years, the average was 76.8 years,of which 18 cases wcre treated with DCS,where 36 with DHS, 12 cases with Gamma nail ,24 cases with PEN ,20 cases with hip arthroplasly. All patients were followed - up belween 6 months to 5 years, the average was 3.1 years. Results According to Harris hip score criterion ,the rates of excellent and good results in DCS was 81.3% ,where 91.7% in DHS, 83.3% in Gamma nail, 95.8 % in PFN,100% in hip arthroplasty. Conclusion The hip arthroplasly is a good method in the treatment of intertrochanteric fractures hecase of less bed time, postoperative complications than internal fixation group , especially for the severe osteoporosis with comminuted fracture. Different kind of internal fixations should be a good method in the treatment of intertrochanteric fractures if their indications are used correctlly. Less bleeding is in PFN than in other group.