亚急诊手术治疗老年股骨转子间骨折的疗效分析

Subemergency treatment of femoral intertrochanteric fractures in elderly patients

目的探讨亚急诊手术治疗老年股骨转子间骨折的临床疗效。方法回顾性分析2013年6月至2014年2月期间通过亚急诊或择期手术治疗且获得随访的47例老年股骨转子间骨折患者资料。根据受伤至手术时间不同分为2组：亚急诊手术组20例，男9例，女11例；平均年龄为（72．2±4．8）岁；骨折Evans—Jensen分型：Ⅰ型2例，Ⅱ型5例，Ⅲ型5例，Ⅳ型5例，V型3例；受伤至手术时间平均为0．8d（0．5～1．7d）。择期手术组27例，男11例，女16例；平均年龄为（74．9±5．7）岁；骨折Evans．Jensen分型：Ⅰ型3例，Ⅱ型6例，Ⅲ型6例，Ⅳ型7例，V型5例；受伤至手术时间平均为3．4d（2。5d）。比较两组患者住院期间并发症发生率、骨折愈合时间、住院时间和末次随访时髋关节功能等。结果所有患者术后获平均13．4个月（12～15个月）随访。亚急诊手术组患者住院期间并发症发生率（35．0％，7／20）显著低于择期手术组患者（51．9％，14／27），住院时间[（12．1±1．6）d]显著短于择期手术组患者【（16．1±1．8）d】，差异均有统计学意义（P〈0．05）。亚急诊手术组与择期手术组患者骨折愈合时间平均分别为（13．1±1．8）、（13．6±1．2）周，差异无统计学意义（P〉0．05）。末次随访时髋关节功能：亚急诊手术组优16例，良2例，可1例，差1例，优良率为90．0％；择期手术组优21例，良2例，可2例，差2例，优良率为85．2％，两组比较差异无统计学意义（P〉0．05）。结论亚急诊手术治疗老年转子间骨折能够降低住院期间并发症的发生率，缩短住院时间。

Objective To investigate the clinical effects of subemergency treatment of femoral in- tertrochanteric fractures in elderly patients. Methods From June 2013 through February 2014, 47 patients older than 65 years were treated for femoral intertrochanteric fracture at our department and completed full fol- low-ups. Of them, 20 received subemergency operation. They were 9 men and 11 women, with an average age of 72.2 ± 4. 8 years. By the Evans-Jensen classification, there were 2 cases of type Ⅰ, 5 of type Ⅱ 5 of typeⅢ , 5 of type Ⅳ, and 3 of type V. The time from injury to surgery ranged from 0.5 to 1.7 days （average, 0. 8 days）. The other 27 patients underwent selective operation. They were 11 men and 16 women, with an average age of 74. 9± 5.7 years. By the Evans-Jensen classification, there were 3 cases of type Ⅰ, 6 of type Ⅱ, 6 of type Ⅲ, 7 of type Ⅳ, and 5 of type Ⅴ. The time from injury to surgery ranged from 2 to 5 days （average, 3.4 days）. We compared the 2 groups in terms of inhospital complications, fracture healing time, length of hospital stay, and hip scores at the last follow-up. Results All the patients were followed up for 12 to 15 months （mean, 13.4 months）. The rate of in-hospital complications in the subemergency operation group （35.0%, 7/20） was significantly lower than that in the selective operation group （51.9%, 14/27）, and the length of hospital stay in the former （12.1 ±1.6 days） was significantly shorter than in the latter （16. 1 ± 1.8 days） （ P 〈 0. 05）. There was no significant difference between the 2 groups in fracture healing time （13.1 ± 1.8 weeks versus 13.6 ± 1.2 weeks） （ P 〉 0. 05 ）. According to the hip scores at the last follow-up, the subemergency operation group had 16 excellent, 2 good, one fair and one poor cases （with an excellent to good rate of 90. 0% ） while the selective operation group had 21 excellent, 2 good, 2 fair and 2 poor cases （with an excellent to good rate of 85.2% ）, showing no significant difference between groups （ P 〉 0. 05 ） . Conclusion Subemergency operation can reduce not only in-hospital complications but also length of hospital stay for old patients with femoral intertrochanteric fracture.