老年股骨粗隆间骨折的手术治疗

目的探讨老年股骨粗隆间骨折的治疗方法及效果。方法2000年1月至2005年1月,治疗160例老年股骨粗隆间骨折患者,平均年龄78岁,95%合并内科疾病。其中保守治疗8例,切开复位内固定术116例(DHS治疗60例,PFN治疗56例),人工关节置换36例。结果所有患者均获得12~24个月的随访,保守治疗及切开复位内固定组骨折均愈合,无不愈合及死亡病例。人工关节组无术后早期脱位、人工假体下沉、断裂、松动等并发症发生。所有患者日常生活能自理,无严重疼痛、功能障碍,疗效满意。按H arris评分标准,优良率保守治疗组为70%,DHS组90%,PFN组87.5%,人工关节组92.3%。结论对老年股骨粗隆间骨折,应积极进行手术治疗,充分术前准备,根据患者的健康状况及骨折类型选择适合不同患者的治疗方法,减少骨折并发症的发生,提高老年人的生活质量。

Operative Treatment of Old-age Patients with Intertrochanteric Fracture

Objective To discuss the method and clinical results of old-age patients with intertrochanteric fractures.Methods From January 2000 to January 2005,160 cases with intertrochanteric fractures were treated in our department.The average age of the patients was 78 years old,95% of them suffered from complicated medical disease.8 of them were treated with conservative traction,116 of them were treated with internal fixation(60 with dynamic hip screws,56 with proximal femoral nail),and 36 of them were treated with artificial joint.Results All the patients were followed up for 12 to 24 months.All the fractures healed and no one died in conservative and internal fixation group.There was no earlier period dislocation,sinking or softening and breaking of prosthesis in artifical joint group.All of the patients could take care of daily life by themselves and were satisfied with the outcome.No serious pain or dysfunction were found in the patients.According to Harris score system,the excellent and good rate is 70% in conservative group,90% in DHS group,87.5% in DHS group,and 92.3% in artificial joint group respectively.Conclusion Operative treatment should be performed in old-age patients with intertrochanteric fractures actively.The preoperative preparation should be done sufficiently.Proper method should be determined on the basis of physical conditions and fracture types of the different patients.The final therapeutic objective is to decrease complications of fracture and improve the quality of life of the old people.