老年型骨质疏松患者转子间骨折治疗创伤分析

Analysis of Surgical Methods on Elderly Patients with Osteoporotic Intertrochanteric Hip Fracture

目的探索适合老年型骨质疏松症患者转子间骨折固定可靠而且对身体干扰小的个体化治疗方法。方法回顾分析248例手术治疗老年型骨质疏松症患者转子间骨折的临床资料,其中开发性手术124例,微创治疗124例。结果①开放治疗骨折平均临床愈合时间11.8周,微创治疗骨折平均临床愈合时间9.6周;开放手术术后并发症发生率24.2%、死亡5例,微创治疗术后并发症发生率为12.0%、无死亡病例。②12～24周按黄公怡疗效评定标准开放手术患者优90.3%、良9.7%、差0:微创治疗患者优91.9%、良8.1%、差0。结论①开发性手术和微创手术治疗老年型骨质疏松症患者转子间骨折在疗效方面没有明显差异,但微创手术术后并发症发生率远低于开发性手术。②微创手术骨折愈合时间比开放手术有明显缩短。③老年型骨质疏松症患者转子间骨折治疗应综合全身因素、骨折情况、骨质疏松程度及患者可接受情况选择个体化治疗方法,手术在达到固定可靠、支撑牢固条件时尽量选择转子区骨量丢失较少、创伤小的微创方法。

Objective To study the individualized treatment of elderly patients with osteoporotic intertroehanteric fracture.Methods 248 old patients with osteoporotic intertrochanteric fracture were investigated,including open reduction 124 cases,minimally invasive 124 cases.Results ①The mean healed clinically of open reduction was 11.8 weeks,the mean healed clinically of minimally invasive was 9.6 weeks;the peri-operative indices of open reduction was 24.2%,with five died;the peri-operative indices of minimally invasive was 12.0%,with no death.②All cases were followed up from 12 to 24 weeks,the excellent rate of open reduction was 90.3%,good 9.7% and the excellent rate of minimally invasive was 91.9%,good 8.1%.Conclusion ①There were no significant difference in clinical efficacy between open reduction and minimally invasive,but the complication indices of minimally invasive were less than that of the open reduction;②The healing time of fracture of minimally invasive was less than that of open reduction;③The method of minimally invasive was simple,fixed firmly,less bleeding in treatment of elderly patients with osteoporotic intertrochanteric fracture.