老年股骨粗隆下骨折的手术治疗

目的：探讨老年股骨粗隆下骨折的手术治疗方法。方法：自2003年12月～2008年3月，对34例老年股骨粗隆下骨折患者采用闭合复位、DCS内固定治疗，男16例，女18例，年龄75～96岁，平均81．2岁。合并内科疾病33例，占97．1％，合并两种以上疾病患者21例，占61．8％。手术前请内科会诊协助诊治内科疾患，约5-10天后手术，术后常规进行个体化康复和骨质疏松的治疗。结果：所有病例随访9～36个月，平均17个月，未发生心腑肝肺并发症，均骨性愈合，无钢板松动、断裂、骨不连等并发症。2例出现轻度髋内翻，根据HSS髋犬节评分法评定功能，优14例，良16例，可4例。优良率88.2％。结论：积极处理内科疾病、个体化康复训练、积极治疗骨质疏松以及牢固的固定是治疗老年股骨粗隆下骨折的关键。

Surgical Treatment of the Elderly Subtrochanteric Fracture

Objective： To study the surgical treatment method of the elderly subtrochanteric fracture. Methords： From December 2003 to March 2008, 34 cases of subtrochanteric fracture were treated with dynamie condylar screw. In this study, there are 16 males and 18 females with an average age of 81.2 years （ranged from 75 to 96 years）, 33 eases （97.1%） combined with medical illness before operation, 21 cases （61.8%） were found to have two or more kinds of medical illness. Preoparative preparation was 5-10 days, internal medical doctors were invited to diagnose and cure the medical illness. Individual healing exercise and active treatment for osteoporosis were general carried out after operation. Results： The follow-up durantion was 9-36 months （average 17 months）. None of complications happened in heat, brain, liver and lung. All fractures healed without any complications of hardware fixation, 2 cases hand lightly coxa vara. According to HSS＇s scores, the result was evaluated as excellent in 14 cases, good in 16 cases and fair in 4 cases. The excellent and good rate was 88.2%. Conclusion： Active treatment for medical disease, individual healing exercise, active treatment for osteoporosis and ideal fixation are the keys of treatment for the elderly subtrochanteric fracture.