老年骨质疏松性股骨粗隆间骨折的手术治疗策略

目的 探讨老年骨质疏松性股骨粗隆间骨折的手术治疗方法.方法 选择老年骨质疏松性股骨粗隆间骨折242例,根据不同类型采用不同的治疗方法,加压空心螺纹钉组24例,动力型加压髋螺钉组173例,动力型加压髁螺钉组45例.比较各组手术时间、出血量、骨折愈合时间,以及并发症发生情况.结果 术后随访1～7年,平均37个月.加压空心螺纹钉组手术创伤小,手术时间及术中出血量、术后并发症均明显少于其他手术组(P＜0.05),其余两组比较差异均无统计学意义.结论 3种手术方法各有优缺点,术前应正确地评估患者生理和心理状态和分析骨折类型,合理选择内固定方式和正确的康复锻炼计划,合理地制定治疗策略.

Operation for Hip Osteoporotic Femoral Intertrochanteric Fracture in Elderly Patients

Objective To explore and investigate the operative method for hip osteoporotic femoral intertrochanteric fracture in elderly patients.Methods A total of 242 elderly patients with osteoprotic femoral intertrochanteric fracture were divided into three groups and treated from January 1998 to June 2005 with different operative methods.One group with 24 patients was treated with CLS;the second group with 173 patients was treated with DHS;the third group with 45 patients was treated using DCS.The operation time,blood loss,fracture healing time,and operation complications were compared among three groups.Results After operation,the patients were followed up from 1 year to 7 years with 37 months on the average.There were significantly less injury,short operation time,less blood loss,and post-operation complications in group CLS compared to those in other groups(P<0.05).Nevertheless,the difference between the other two groups(DHS and DCS)is not statistically significant.Conclusion Three operative methods have their own advantages and disadvantages.The excellent clinical effect can be achieved,if the physical and psychological status of patients are appraised correctly,the types of fractures are analyzed exactly,the internal fixation,rehabilitation exercise and the therapy plans are chosen rationally before operations.