微创闭合复位结合外固定架治疗老年股骨粗隆间骨折

Minimal invasion and closed reduction with external fixation for elderly femoral intertrochanteric fracture

目的：探讨微创闭合复位结合外固定架治疗老年股骨粗隆间骨折的临床疗效。方法：2007年8月至2013年9月,采用微创闭合复位结合外固定架固定治疗股骨粗隆间骨折43例,男26例,女17例;年龄68-92岁,平均78岁;受伤至手术时间1-8 d,平均3 d。按照AO分型：A1型22例,A2型15例,A3型6例。观察术后骨折的愈合时间,并采用Harris评分系统对治疗效果进行评价。结果：43例患者均获得随访,时间10-18个月,平均13个月。手术切口在拔除外固定后Ⅰ期/甲级愈合,骨折均愈合,愈合时间12-18周,平均16周。2例股骨粗隆部螺纹针松动,2例髋内翻畸形,1例延迟愈合。无骨不连、外固定物断裂、血管神经损伤病例。术后Harris髋关节评分为85.89±7.36,优18例,良19例。结论：微创闭合复位结合外固定架治疗老年股骨粗隆间骨折可获得良好的临床疗效,对不能耐受麻醉和手术创伤的老年患者是一种简单、有效的治疗方法。

Objective：To evaluate the clinical effects of minimal invasion and closed reduction with external fixation in treating elderly femoral intertrochanteric fracture. Methods：From August 2007 and September 2013,43 patients with elderly femoral intertrochanteric fracture were treated by minimal invasion and closed reduction with external fixation. There were 26 males and 17 females with an average age of 78 years old ranging from 68 to 92 years. Durations from injury to operation ranged from 1 to 8 days with an average of 3 days. According to AO classification,there were 22 cases with type A1,15 with type A2,6with type A3. The time of bone healing were observed after operation and the clinical effects were evaluated by Harris scoring standard. Results：All patients were followed up from 10 to 18 months with an average of 13 months. The incisions obtained one stage healing after removal of external fixation. All the fractures were healed and the mean healing time was 16 weeks（ranged,12 to 18 weeks）. Two patiens complicated with the thread needle loosening in the femoral trochanteric,2 cases with the hip varus deformity and 1 case with the delayed union. No bone nonunion,external fixer breakage,blood vessel or nerve damage were found. According to the Harris scoring standard,the average Harris score of hip joint function was 85.89 ±7.36,and 18 cases got excellent results,19 good. Conclusion：Minimal invasion and closed reduction with external fixation can obtain satisfactory results in treating elderly femoral intertrochanteric fractures. It is a simple and effective method for elderly patients who cannot tolerate anesthesia and surgery trauma.