老年股骨粗隆问骨折内固定治疗策略及疗效分析

目的探讨老年股骨粗隆间骨折内固定方法的选择及疗效。方法回顾2008年1月-2013年2月间，我院治疗的老年股骨粗隆间骨折患者102例，术前均进行MullerAO分型及Singh分级，按照分型及分级结果选择动力髋（DHs）固定、股骨近端锁定钢板（LCP）或髓内钉定；全部手术均由同一组医生完成，手术治疗中要求复位良好，规范应用内固定技术；术后均常规给予预防下肢深静脉血栓形成（DVT）、抗骨质疏松及康复治疗。记录患者手术时间、术中出血量、术后并发症及术后髋关节功能恢复情况，进行分析比较。结果随访时间3个月～18个月，平均12．7个月，按照董纪元等髋关节疗效评分标准进行评价，优54例，良42例，可4例，差2例。优良率94．1％。未发生心肺脑并发症，无感染、DVT及死亡病例发生。三组在平均手术时间及术中平均出血量，髓内钉组显著优于其他两组，有统计学意义，LCP组与DHS组之间差异无统计学意义。术后三组疗效比较无统计学意义。结论对于老年股骨粗隆间骨折，选择合适的内固定方式是治疗成功的基础；良好的复位、规范地应用内固定技术，术后积极预防并发症及康复治疗是减少术后并发症及获得良好疗效的关键。

Clinical analysis and the treatment of eider femoral intertrochanteric fracture

Objective To study the clinical effects of internal fixations in the treatment of elder femoral intertrochanteric fractures. Methods 102 patients with intertrochanteric fractures were treated by internal fixations. According to Muller AO and Singh classification system, the suitable internal fixation was choose＆ Good reduction and rational technology were used on surgery. Healing exercise, compositive prevention to DVT and active treatment to osteoporosis were general carried through after operation. The data were collected for clinical analysis on the following aspects： the operative pro-cedure post-operative restored function and complications. Results All these patients were griven a follow-up between 3 to 18 months, average follow-up was 12.7 months. The results were excellent in 54 patients, good in 42 patients, fair in 4, and poor in 2, according to Dong Jiyuan rating scores, with 94.1% of excellent and good functions of hip. There were statistical difference in the mean operation time and the blood loss among the DHS fixation group, Gamma nail fix ation group and intramedullary nail fixation group, but no statistical difference in the post-operative restored fimction am ong them. Conclusions The suitable internal fixation, good reduction, rational technology, healing exercise, compositive prevention to DVT and active treatment to osteoporosis were the key to avoid the complications and achieve good clinical effects.