股骨粗隆间骨折治疗方法选择

Choice of Treatment Methods for Femoral Intertrochanteric Fractures

目的总结不同内固定治疗股骨粗隆间骨折的选择原则。方法随机选择该院2011年1月-2016年12月收治的53例股骨粗隆间骨折患者为研究对象,根据患者年龄、骨折类型、股骨髓腔大小、预期寿命,分别选择股骨近端髓内钉、股骨近端解剖型钢板、动力髋加防旋螺钉、骨水泥型人工股骨头置换。对1~2型选用动力髋加防旋螺钉固定;对年轻、骨质质量好、股骨髓腔狭窄患者选用股骨近端解剖钢板;对偏股骨颈基底、预期寿命短、合并疾病多的患者选择加长型骨水泥型人工股骨头置换术;对偏粗隆下、预期寿命长患者选择股骨近端髓内钉。结果该组患者均获随访,1例患者死于围手术期,死因为肺栓塞;1例PFNA内固定,发生股骨颈内叶片状主钉松脱;3例发生髋内翻畸形。其余患者骨性愈合,恢复行走功能。结论根据不同骨折类型,结合患者年龄、股骨髓腔大小,选择不同治疗方法,治疗股骨粗隆间骨折,可以取得良好治疗效果。

Objective To summarize the selection principles of different internal fixation for intertrochanteric fractures.Methods 53 cases of intertrochanteric fractures of femur treated in the hospital from January 2011 to December 2016 were conveniently selected.According to the patient's age,fracture type,femoral bone marrow cavity size,life expectancy,the proximal femoral intramedullary nail and femoral proximal end anatomic steel plate,dynamic hip with anti-rotation screw,cemented artificial femoral head replacement.Methods For the type 1-2,dynamic hips and anti-rotation screws were used.For young,good bone quality and femoral bone marrow stenosis,the proximal femoral anatomical plate was selected.For the femoral neck base,the life expectancy is short and the patients with complicated disease chose extended cemented artificial femoral head replacement.For patients with long life expectancy,the proximal femur intramedullary nail was selected.Results All patients in this group were followed up.One patient died during perioperative period,died of pulmonary embolism,one case had PFNA internal fixation,lobular main nail loosening occurred in femoral neck,and three cases had hip varus deformity.The rest of the patients healed bones and recovered walking function.Conclusion According to different fracture types,combined with the patient's age and the size of the femoral bone marrow cavity,different treatment methods can be selected to treat femoral intertrochanteric fractures,which can achieve good results.