老年股骨转子间骨折的手术治疗选择

目的：探讨老年股骨转子间骨折的有效治疗方法。方法：对采用动力髋、股骨近端解剖钢板和人工股骨头置换3种手术方法治疗的66例老年股骨转子间骨折患者进行随访、分析。结果：1例死亡，其余患者伤121均顺利愈合出院，6个月时内固定组骨折均顺利愈合，均可较自由地活动。其中动力髋螺钉组31例，1例术后1h死于急性肺梗塞，5例出现轻度的骨折端嵌压，9例伴有轻度的髋部疼痛。股骨近端解剖钢板组25例，4例有轻度～中度的髋内翻，5例出现轻度髋部疼痛。人工股骨头置换组10例，2例出现轻度髋部疼痛和跛行。结论：以上3种方法各有优缺点，适用于不同条件的股骨转子间骨折患者，术前根据患者的年龄、受伤前活动能力、全身情况、骨折类型及局部骨质条件，结合各种手术方法的特点，综合考虑，选择其一，均可取得满意的临床效果。

The option of operative methods for aged intertrochanteric fractures

Objective:To explore effective treatment methods for aged intertrochanteric fractures.Methods: A total of 66 aged patients with intertrochanteric fractures treated with dynamic hip screw(DHS,n = 31),proximal(femoral) anatomic plate(PFAP,n = 25) and bipolar femoral head replacement(BFHR,n = 10) were analyzed retrospectively.Results: All patients were followed up for more than 6 months.One patient died 1 hour after the operation of DHS.All the rest were discharged uneventfully and can move freely 6 months after the operations.Of the 31 patients treated with DHS,1 died from acute pulmonary infarction after operation,5 showed mild collapse in the fracture sites,and 9 moved with mild hip pain.Of the 25 patients fixed with PFAP,4 got mild to moderate coxa vara,and 5 had mild hip pain.In the 10 patients treated with BFHR,2 got mild hip pain and limp.Conclusion: All of the three treatment methods have advantages and disadvantages and should be selectively used in the(treatment) of aged intertrochanteric fractures based on disease status.