骨质疏松性髋部骨折的治疗

Treatment of hip fracture with osteoporosis

目的提高髋部脆性骨折治愈率，降低伤残率。方法对108例髋部脆性骨折患者资料进行回顾性分析，平均随访23个月。探讨Singh分级、治疗措施与预后的关系。结果①SinghⅢ～Ⅵ级者行内固定术，Ⅰ～Ⅱ级者行人工关节置换，优良率为83．3％；②内固定与人工关节置换的并发症发生率分别为11．4％、7．9％（P〉0.05）；③脆性骨折经口服阿仑膦酸钠5个月后，94．4％的患者Singh分级不变；④预防使用抗生素由平均6．9d减为1．7d，术后感染未增多（P〈0.05）。结论Singh指数为基层医院了解股骨近端骨质疏松程度的一种方法；内固定或人工关节置换治疗高龄髋部脆性骨折，并发症不少；脆性骨折术后应使用阿仑膦酸钠；限制使用抗生素不会增加骨科内植物术后感染率。

Objective To increase the cure rate and decrease the disability rate of osteoporotic hip fracture.Methods The data of 108 cases of osteoporotic hip fracture was analyzed retrospectively, the average time of follow-up was 23 months, the relationship between Singh index, curing methods and prognosis was investigated. Results ①The patients from class Ⅲ to class Ⅵ were applied internal fixation of fracture reduction, and those patients from Class Ⅰ to Class Ⅱ were applied hip arthroplasty, the satisfactory late was 83.3%.②The postoperative complication rate of internal fixation cases was 11.4%, and the postoperative complication rate of hip arthroplasty cases was 7.9%（P〉0.05）. ③Five months after taking alendronate sodium, the Singh index of 94.4% of patients with osteoporotic fracture was the same as before operation. ④The time of antibiotic prevention is reducing from 6.9 days to 1.7 days after intervention. And no cases was postoperative infected （P〈0.05）.Conelusion Singh index is a method for basic hospitals to know the level of proximal femoral osteoporosis; the postoperative complication rate of senior patient with hip osteoporotic fracture is high both after internal fixation and hip arthroplasty; patients with osteoporotic fracture should take alendronate sodium after operation; the limit use of antibiotic would not increase the infection rate after orthopedics implant surgery.