老年人股骨粗隆间骨折的治疗选择

目的:探讨老年人股骨粗隆间骨折的治疗选择。方法:2006年6月至2010年6月手术治疗老年人股骨粗隆间骨折58例,男25例,女33例;年龄65～93岁,平均79岁。按Evans分型:Ⅰ型30例,Ⅱ型28例。58例中25例采用关节置换治疗(A组),33例采用内固定治疗(B组)。对两组的手术时间、术中出血量、术后下床活动时间、引流量、并发症及关节活动功能进行比较,其中关节活动功能采用Harris评分分别在术后3,6,12个月进行评定。结果:所有病例均获得1年以上随访,A组1例患者术后1个月并发肺炎死亡,其余患者均安全度过围手术期。B组在手术时间、术中出血量、引流量方面均优于A组。并发症:A组死亡1例,深静脉血栓1例,尿路感染2例,肺炎1例;B组发生褥疮1例,髋内翻1例,尿路感染2例。B组并发症发生率比A组低(χ2=10.1648,P<0.05)。根据Harris评分系统,术后3个月,B组总分(75.45±3.22)分,A组总分(78.43±5.32)分;术后6个月,B组总分(76.33±4.12)分,A组总分(81.67±4.87)分;术后12个月,B组总分(88.65±3.77)分,A组总分(87.66±4.01)分。术后3、6个月两组总分有统计学意义(P<0.05);术后12个月,两组总分无统计学意义(P>0.05)。术后3个月:A组优14例,良5例,中5例,差1例;B组优8例,良13例,中9例,差3例。术后6个月:A组优18例,良5例,中2例,差0例;B组优10例,良15例,中6例,差2例。术后12个月:A组优18例,良5例,中1例,差1例;B组优21例,良9例,中3例,差0例。术后3、6个月,A组的疗效优于B组(P<0.05),但到术后12个月,两组疗效差异无统计学意义(P>0.05)。结论:老年人股骨粗隆间骨折应首先选择内固定治疗,关节置换主要适用于肿瘤引起的病理性骨折、被忽视的骨折畸形以及股骨干骨质差无法采用或尝试内固定治疗的患者、或同侧症状性退行性关节病的患者、内固定失败的翻修以及粗隆间粉碎骨折比较重且合并严重骨质疏松者。

Therapic choice of intertrochanteric fracture of femur in aged patient

Objective:To investigate the therapic choice of intertrochanteric fractures of femur in aged patient. Methods:From June 2006 to June 2010,58 patients with intertrochanteric fracture were treated with surgical methods. There were 25 males and 33 females,aged from 65 to 93 years old (averaged 79 years old). According to the Evans type,typeⅠwas in 30 cases,typeⅡ was in 28 cases. Of them,25 patients were treated with hip replacement(group A) and 33 patients were treated with internal fixation(group B). The operative time,blood loss volume,the time of get out of bed,drainage volume,complications and function of joint motion were compared between two groups. According to Harris scoring to evaluate function of joint motion at the 3rd,6th,12th months after operation. Results:All patients were followed up more than 12 months(averaged 16.4 months). One patient in group A died of pneumonia one month later after operation and other patients live safely through peri-operation. The group B was better than that of group A at operative time,blood loss volume,drainage volume. In group A,1 case died and 1 case got DVT,2 cases got urinary tract infection and 1 case got pneumonia. While in group B,1 case got bedsore,1 case got coxa vara and 2 cases got urinary tract infection. The incidence rate of complication in group B was lower than that of group A(P<0.05). According to Harris scoring system,at the 3rd,6th,12th months after operation,Harris scoring in group A was respectively(78.43±5.32),(81.67±4.87),(87.66±4.01)scores and in group B was respectively(75.45±3.22),(76.33±4.12),(88.65±3.77) scores. There was statistical significance in Harris scoring at the 3rd,6th months after operation between two groups(P<0.05)and there was no statistical significance at the12th months after operation(P>0.05). At three months after operation,in group A,14 cases obtained excellent results,5 good,5 fair and 1 poor;and in group B,8 cases obtained excellent results,13 good,9 fair and 3 poor. Six months later,in group A,18 excellent,5 good,2 fair and 0 poor,and in group B,10 excellent,15 good,6 fair and 2 poor. Twelve months later,in group A,18 excellent,5 good,1 fair and 1 poor;and in group B,21 excellent,9 good,3 fair and 0 poor. Three and six months later after operation,the clinical effect in group A was better than that of group B(P<0.05);but twelve months later,there was no significant differences between two groups(P>0.05). Conclusion:The internal fixation is especially the preferred method for the aged patient with intertrochanteric fractures. Hip replacement refer to pathologicalfracture caused by cancer,unheeded fracture abnormity,osteoprosis too serious to be treated by internal fixation or patients with ipsilateral symptomatic degenerative joint or revisions caused by failed internal fixation and severely intertrochanteric comminuted fractures and merged severely osteoporosis.