分次复位手术技术治疗老年股骨粗隆部骨折

Intraoperative staged reduction for femoral intertrochanteric fracture in the elderly

[目的]探讨分次复位理念在手术治疗老年股骨粗隆部骨折中的效果。[方法]2009年6月~2013年10月,手术治疗老年股骨粗隆部骨折65例,其中男27例,女38例;年龄69~99岁,平均79岁。所有病例术前术后均详细评估,并存内科疾病者占83.08%,同时并存两种以上内科疾病者49.23%,以分次复位的理念应用Gamma3髓内钉治疗股骨粗隆间骨折,术中辅助单钩技术进行再次辅助复位,并应用改良的综合伴随疾病指数进行评估。术后常规进行下肢功能锻炼,术后6周、半年复查股骨正侧位X线片。[结果]所有病例均获随访,随访时间7~28个月(平均20个月);所有患者分别按髋关节功能评分标准评估,本组病例疗效满意、功能恢复好,65例中除1例术后1个月内并发心梗死亡外,其余患者骨折全部愈合,并发症发生率为16.92%。[结论]股骨粗隆间骨折多为高龄老人,常合并多种严重的内科疾病,外科治疗是首选。分次复位在老年股骨粗隆间骨折患者的手术治疗应用中可达到较好复位,临床效果满意。

[Objective] To investigate the clinical outcome of intraoperative staged reduction for femoral intertrochanteric fractures in elderly patients. [Method] From June 2009 to June 2013, 65 patients with femoral intertrochanteric fractures, in- cluding 27 males and 38 females with an average age of 79 years, were surgically treated with Gamma 3 intramedullary nailing. Of them, 83.08% of the patients were complicated with general diseases, and 49.23% patients had more than two diseases con- currently, including the cardiovascular diseases, diabetic and so on. After anesthesia, an axial traction was applied as the pa- tient was placed on fracture table to diso, subsequently manual reduction was performed with adduetion and internal rotation of the affected limb. After incision made, further reduction of the fracture was achieved by leveraging force with a retractor or hook. Subsequently, the fracture was fixed with Gamma 3 intramedullary nail. Postoperatively, rehabilitation of the involved ex- tremity was conducted and the radiological examination was taken at 6 weeks and 6 months postoperatively. [ Results ] All 65 patients were followed up for 7 months to 28 months with an average of 20 months. All patients achieved satisfactory results of the hip function based on the evaluation criteria. Except a patients who died of myocardial infarction all of the remaining pa- tients got solid bone healing with the complication rate of 16.92%. [Conclusion] The surgical treatment is the first choice for complex intertrochanteric fracture. It has been found in this study that integrity of great trochanter lateral cortex, the continuity of medial cortex and tip apex distance TAD could seriously affect the clinical results and function of hip joint.