老年转子间骨折外科治疗方法选择

Surgical approaches for intertrochanteric fractures in elder patients

目的对老年转子间骨折手术方式选择的长期疗效随访并分析。方法分析安阳市三个市级医院骨科2005至2009年手术治疗的老年转子间骨折402例，参照Singh指数分型方法的分类法指导选择骨水泥型人工股骨头置换术、内固定术实施治疗，其中I型骨折17例（4％），II型骨折49例（12％），Ⅲ型骨折287例（72％），Ⅳ型骨折48例（12％）。应用针对性的生活动作功能评分随访术后1～5年，统计骨科并发症、康复时间和功能评分结果。结果骨折分型指导术式选择治疗，术后多数患者术后1个月恢复自理。术后3个月及1年关节功能随访优良率分别为：I型为70．6％和100．0％；Ⅱ型内固定为57．9％和89．4％，Ⅱ型关节置换为85．7％和86．7％；Ⅲ型为85．4％和92．0％；IV型为72．9％和87．5％。Ⅱ型骨折内固定失败2例（5％），关节置换感染6例（1．9％）。5年随访未发现髋臼过度磨损、假体松动等远期并发症。结论合理的手术方式选择可以显著降低术后内固定术失败率，缩短康复周期，远期随访结果满意。

Objective To conduct long-term follow-ups on the efficacies of surgical approaches for iutertrochanteric fractures in elder patients. Methods The outcomes of intertrochanteric fractures in 402 elder patients undergoing different surgical procedures during 2005 to 2009 were reviewed. The modified classification of Singh index, detailed surgical contraindications and improved functional scoring system specialized for intertrochanteric fracture were included. Among these, type I to IV had 17 cases （4%） ,49 cases （ 12% ）, 187 cases （72%）, 48 cases （ 12% ）. The follow-up period was 1 - 5 years. The orthopedic complications, rehabilitation duration and functional scores were reviewed. Results Most patients achieved self-care at 1 month post-operation. The failure rate of internal fixation was 5% and infection rate 1.9% in hemiarthroplasty, type I to IV had 70. 6% and 100.0%, 85.7% and 86. 7%, 85.4% and 92.0% ,72.9% and 87.5% cases showed excellent or good outcomes at 3 month and 1 year. During a follow-up period of 5 years, there was no occurrence of prothetic loosening or excessive wear of acetabular. Conclusion A rational selection of surgical approaches may markedly reduce the failure rate of internal post-operative fixation and shorten the rehabilitation period. And the long-term follow-up outcomes are satisfactory.