老年股骨转子周围骨折的治疗策略

目的探讨手术治疗老年转子周围骨折的主要并发症的原因及应对措施。方法回顾分析75岁以上老年股骨转子周围骨折261例（265髋）手术治疗病例的术前、手术及术后情况。患者平均年龄为79．5岁（75-96岁）,术前平均患有2．6种全身性疾病。转子问骨折230髋,转子下骨折35髋。分别采用DHS、DHS＋环抱钢板、Gamma钉、股骨近端钉及股骨短重建钉治疗。结果平均手术时间73min。224例（227髋）随访超过6个月,随访率86％。平均随访13．2个月（6-58个月）。206例骨折愈合（92％）。术后6个月功能优良率81％。术中术后并发症包括心脑血管意外、肺部感染及呼吸功能衰竭、营养障碍、深部静脉血栓形成等。结论不同类型的老年股骨转子周围骨折应选用不同的手术方法。选择恰当的麻醉及固定方式有助于术后康复,减少并发症,降低致残及致死率,提高生活质量。

Strategy for treatment of peritrochanteric fractures in senile patients

Objective To analyze the clinical manifestations,operative applications,complications and outcomes of peritrochanteric fracture of femur in patients 75-years old and over.Methods The clinical data of 261 patients,aged 79.5(75~96),of peritrochanteric fracture(265 hips)were analyzed.(Results The)incidence of different accompanied medical diseases was 2.6/person on average.The internal fixation methods included DHS,DHS plus trochanteric steady plate or intramedullary interlocking nails,such as Gamma nail,PFN and reconstructive nails.The mean operation time was 73 minutes.224 cases were followed-up over 6 months after operation 81% of which got excellent or good results.The complications included acute heart failure,brain infarction,cerebral thrombosis,pulmonary embolism,deep venous thrombosis of lower extremities,lung infection,and stress ulceration,bed sore,and acute respiratory failure.Thirteen cases died of cardiopulmonary insufficiency,cardiac infarction,brain thrombosis,or pulmonary embolism.Conclusion Complications are frequent in aged patients.Appropriate operative menthods help reduce complications and mortality rates.