老年人股骨转子间骨折围手术期的治疗分析

The treatment of intertrochanteric fracture in aged patients and morbidity during the perioperative period

目的 探讨老年人股骨转子间骨折的治疗方法及围手术期的并发症。 方法 1986年 1月～ 1998年 5月手术治疗 60岁以上老年人股骨转子间骨折 229例。随访 149例，男 45例，女 104例；年龄 60～ 96岁，平均 77.5岁。按照 Evans分型，Ⅰ 型 32例，Ⅱ 型 71例，Ⅲ型 40例，Ⅳ型 3例，Ⅴ型 3例。有 5例分别合并肱骨骨折（ 3例）、 Colles骨折（ 1例）和尺桡骨骨折（ 1例）。 112例并存内科疾病，占 75.2％。分别为心血管系统疾病 97例次（ 86.6％），脑神经系统疾病 23例次（ 20.5％），呼吸系统疾病 19例次（ 16.9％），内分泌－代谢系统疾病 12例次（ 10.7％），泌尿系统疾病 9例次 (8.0％），消化系统疾病 7例次（ 6.3％）及其他疾病 12例次（ 10.7％）。并存两种以上内科疾病者 56例，占 37.6％。结果 术前住院 1～ 14 d，平均 6.6 d。内固定物包括角状钢板、多枚斯氏针、 Gamma钉、 Ender钉、加压螺纹钉和 Richard钉。随访 4个月～ 5年，平均 30个月。无住院期间死亡的病例，共 19例有并发症发生，其中肺部感染 4例，脑血栓 2例，伤口感染 2例，深部静脉血栓 3例，术后螺钉脱出 2例，肠炎、腹泻 1例，髋内翻 5例，并发症发生率为 12.8％。结论 老年人各脏器机能衰退，多同时合并各种内科疾患。

Objective To discuss the treatment and complications during perioperative period in aged patients with intertrochanteric fractures. Methods From January 1986 to May 1998, 229 cases of intertrochanteric fracture in old persons beyond 60 years were treated, 149 of them had been followed up. There were 45 males and 104 females aging from 60 to 96 years, with an average of 77.5. According to Evans classification system of intertrochanteric fracture, 32 cases belonged to typeⅠ , 71 typeⅡ , 40 typeⅢ , 3 typeⅣ and 3 typeⅤ . One hundred and twelve patients(75.2％ ) suffered preoperatively from medical illness of cardiovascular, central nervous, respiratory, endocrine- metabolic, digestive as well as other systems. 37.6％ of them were found to have two kinds or more of medical diseases. Results The interval between the admission and operative treatment was from 1 to 14 days, with the mean of 6.6 days. The internal fixator included blade plate, multi－ Steinman pins, Gamma nail, Ender pin, compressive screw and Richard nail. The patients were followed up from 4 months to 5 years (average 30 months). None of the patients was dead, the complications during perioperative consisted of pulmonary infection in 4 cases, cerebral thrombosis in 2, wound infection in 2, deep venous thrombosis in 3, failure of internal fixation in 2, coxa varus in 5 and enteritis in 1, the rate of complications was 12.8％ . Conclusion The operative treatment for intertrochanteric fracture in the elderly gave satisfactory results, provided proper surgical preparations, effective treatment of preoperative medical conditions and necessary postoperative treatments were fully paid attention to.