老年股骨粗隆部不稳定骨折的治疗策略

Operative Treatment Strategies for Unstable Femoral Trochanteric Fractures in the Elderly

目的:探讨老年患者股骨粗隆不稳定骨折的治疗方案。方法:选取近几年收治的56例老年粗隆部粉碎性不稳定骨折患者,分别采用了内固定和人工关节置换手术治疗,其中内固定36例,人工关节置换20例。结果:本组平均随访24个月,内固定组出现2例内置物断裂,再次人工关节置换,2例感染,1例清创后好转,1例取出内置物后创口方愈合;人工关节组1例术后关节脱位。术后harris评分内固定组75.6,人工关节组85.6。结论:老年患者,不同程度骨质疏松,较多都伴有不同程度的基础疾病,粗隆部粉碎骨折内置物选择及治疗难度大,人工关节置换对于功能康复及降低并发症等都有明显的优势。

Objective： To investigate the treatment of intertrochanteric fractures of the femur in the eldly patients.Methods： In re-cent years,56 cases of unstable and comminuted intertrachanteric fractures of the eldly,of which 20 cases were treated with hip replace-ment and 36 cases with internal fixation,were analyzed.Results： Average follow-up period was 24 months.in the group of internal fixation,we found,internal instrument breakage occurred in 2 cases,requiring hip replacement,and infection in 2 cases,both achieving wound healing after debridement of one case and extracting internal instrument of the other.By contrast,1 case of joint dislocation occurred after surgery in the group of hip replacement.The Harris hip score were 75.6 for group of internal fixation and 85.6 for group of hip replace-ment respectively.Conclusion： Owing to osteoprosis and basic disease associated with the eldy patients,difficuties in implant choice and treatment for the intertrochanteric fractures,we strongly reckon,hip replacement has greater advantges in improving function and reduc-ing complications.