老年股骨粗隆间骨折不同分型的内固定治疗选择

目的：探讨老年股骨粗隆间骨折不同分型内固定治疗选择。方法：老年股骨粗隆间骨折62例，男40例，女22例；年龄60～82岁，平均71岁。按Evans分型：Ⅰ型16例，Ⅱ型13例，Ⅲ型17例，Ⅳ型10例，V型6例。其中Ⅰ、Ⅱ型29例采用空心钉内固定治疗，Ⅲ、Ⅳ、Ⅴ型33例采用动力加压髋螺钉治疗（DHS）治疗。结果：经1-4年随访，平均2．5年．根据疗效评定的标准，EvansⅠ、Ⅱ型（即稳定型骨折）29例，优13例，良11例，差5例；EvansⅢ、Ⅳ、Ⅴ型（即不稳定型骨折）33例，优18例，良12例，差3例。结论：老年股骨粗隆间骨折不同的分型，分别采用了两种不同的内固定治疗，对EvansⅠ、Ⅱ型的稳定性骨折，多采用了空心钉内固定的治疗，而对EvansⅢ、Ⅳ、Ⅴ的不稳定性骨折，则以动力加压髋螺钉（DHS）内固定为首选。

Treatment of different types of intertrochanteric fractures in the elderly with internal fixation

Objective ：To study the treatment for the different types of intertrochanteric fractures in the elderly with internal fixation. Methods：There were 62 cases of intertrochanteric fractures in the elderly （40 male and 20 female, aged fom 60 to 82 years, with an average age of 71 years）. According to typing of Evans ：there were 16 type Ⅰ , 13 type Ⅱ , 17 type Ⅲ, 10 type IV and 6 type V. Internal fixation with three cannulated screws was applled for the 29 cases of type Ⅰ and type Ⅱ , with dynamic compression hip screw （DHS） for 33 cases of type m , Ⅲ and V. Results ： After 1 to 4 years follow up （mean 2.5 years ）, according to the criteria of curative effect, 13 of 29 cases of type I and Ⅱ （stable fracture） were excellent, 11 good and 5 poor, 18 of 33 cases of type Ⅲ , Ⅳ and Ⅴ （unstable fracture） were excllent, 12 good and 3 poor. Conclusion：Two different internal fixations can be used for different types of intertrochanteric fracture in the elderly. The internal fixation by three cannulated screws is often applied, for the stable fracture （type Ⅰ and Ⅱ ）. For the unstable fracture （type Ⅲ , Ⅳ and Ⅴ ）, internal fixation with dynamic compression hip screw （DHS） is the first selection.