高龄股骨粗隆间骨折手术治疗进展

Progress of Surgical Treatment for Elderly Femoral Intertrochanteric Fracture

近年来中国股骨粗隆间骨折患者已呈高龄化发展态势,由于卧床保守治疗产生的诸多并发症以及患者对预后的较高期望值,所有现有的股骨粗隆间骨折治疗方式以手术为主。其中动力髋螺钉由于其设计原因不适宜应用于伴发骨质疏松的患者,Gamma钉虽经过主钉加长改进,但用于伴发骨质疏松的患者仍存在风险,股骨近端防旋髓内钉(PFNA)及根据亚洲人特点推出的PFNA-Ⅱ因其微创理念及螺旋刀片的独特设计在治疗高龄尤其是伴发骨质疏松的股骨粗隆间骨折患者具有明确优势,髋关节置换可支持患者早期功能锻炼,但需要充分考虑手术适应证。

Elderly patients with intertrochanteric fracture have been increasing year by year. Due to many medical com- plications happen during conservative in-bed therapy and the high recovery requirements from the patients, the main treatment of intertrochanteric fractures comes to surgery. It is not appropriate to choose dynamic hip screw first for patients with intertroehanteric fractures who are also suffering from severe osteoporosis. Although the Gamma nail has been lengthened and improved from the main nail, there are still risks for patients with osteoporosis. Proximal femoral nail anti-rotation （PFNA） and PFNA- II, which is based on the characteristics of Asians, has a clear advantage in the treatment of elderly patients with femoral intertrochanterie fractures, especially for those with osteoporosis, because of its minimally invasive concept and the unique design of the blade. Hip replacement can support early functional exercise of the patients, but the surgical indications should be thoroughly considered.