双侧股骨转子间骨折发病因素分析

Analysis on morbidity factor of bilateral intertrochanteric fractures

目的:通过分析双侧转子间骨折病例资料,了解转子间骨折的致伤因素,为预防多次转子间骨折提供依据。方法:2000年1月至2009年6月研究68例前后两次发生双侧转子间骨折的患者,男31例,女37例;年龄42～95岁,平均75岁。两次骨折AO分型,A1型24髋,A2型96髋,A3型16髋。两次骨折给予手术治疗共128髋,保守治疗8髋。首次骨折治疗康复出院67例,1例因其他并发症转科治疗后出院;再次治疗康复后出院58例,2例死于并发症,8例因其他并发症转科治疗后出院。对前后两次骨折的发病因素进行研究,包括年龄分布、致伤原因、骨折分型、各种伴发的合并症、骨质疏松及治疗情况。结果:患者两次骨折发生平均年龄分别为(73.6±9.25)岁和(76.7±6.74)岁;致伤因素以跌倒为主;再次骨折的AO分型A2型上升至80.88%,更加不稳定;合并症比例高,主要为老年认知障碍、脑中风后偏瘫及视觉障碍;16例接受骨密度测定,骨质疏松明显。结论:骨质疏松和跌倒是多次转子间骨折最主要的致伤因素,合并症的存在是重要的危险因素。因此治疗骨质疏松,加强老年患者的护理和术后康复,注意初次手术的效果,是预防老年再次转子间骨折发生的关键。

To study the morbidity factors of bilateral intertrochanteric fractures by analyzing medical records, so as to provide evidences for preventing the muhiple intertrochanteric fractures. Methods：From Janurary 2000 to June 2009,68 patients with bilateral intertrochanteric fractures were studied, including 31 males and 37 females, ranging in age from 42 to 95 years with an average age of 75 years. There were type A1 in 24 hips,type A2 in 96 hips,and type B3 in 16 hips. One hundred and twenty-eight hips had received surgical treatment, 8 hips were treated with conservative method. On the first in- jury, 67 patients discharged after treatment, 1 patients discharged after treatment in other department. On the second injury, 58 patients discharged after treatment, 2 patients died of complications, 8 patients dischagred after treatment in other department. The risk factors including age,cause of injury,fractures type,complications,osteoporosis and treatment were analyzed. Re- suits ：The average age of two fractures were （73.6＋_9.25） and （76.7___6.74） years;the major injury cause was fall;the A2-type fractures went up to 80.88% on the secondary injury;and the proportion of complications was high, mainly geriatric cognitive disorders,hemiplegic paralysis,and dysopia. Bone mineral density measurement of 16 cases showed marked osteoporosis. Conclusion： Osteoporosis and fall injury contribute mostly to the multiple intertrochanteric fractures. Complication was the dominating risk factor. Treatment of osteoporosis, intensive care, postoperative rehabilitation and effective initial surgery are the key to prevent the secondal,~ intertrochanteric fractures in old DeoDle.