老年人髋部骨折156例临床治疗分析

目的 报告老年人髋部骨折的临床治疗方法，分析老年髋部骨折特点及诊治注意事项。方法 自1997年1月－1999年12月共治疗60岁以上（60－93岁）髋部骨折156例。男性55例，平均年龄71．8岁；女性101例，平均年龄73．1岁。骨折类型：股骨颈骨折94例，男性20例，女性74例；股骨粗隆间骨折62例，男性35例，女性27例。本组接受非手术治疗41例；手术治疗115例，其中行各种内固定手术45例，人工股骨头置换68例，股骨头颈切除2例。部分病例同时给予骨质疏松药物治疗。结果 获得随访110例。随访时间0．5－3．5年。术后下肢静脉栓塞2例，股骨头缺血坏死2例，内固定物松动，滑脱2例，断裂1例，人工股骨头下沉致疼痛4例，术后近期死亡2例（死于心肌梗塞及呼吸道感染），97例（88．2％）恢复行走功能。结论 （1）老年人髋部骨折以女性多见，占64．7％；男性少见，占35．3％。这与女性绝经后骨折疏松症的发生密切相关。而老年股骨颈骨折多见于女性，股骨粗隆间骨折则多见于男性。70岁以后，老年髋部骨折发生率明显上升。这与老年性骨质疏松症的发生明显相关。说明随着年龄的增加，骨折的发生率明显增高，骨折危险性增加。（2）老年人髋部骨折属于骨质疏松性骨折，股骨粗隆间骨折一般都有明确外伤史；而股骨颈骨折常由轻微外力（扭转）所致，因此在诊断时须防止漏诊或误诊，影响治疗效果。（3）老年人多伴有心血管系统或呼吸系统疾病，骨折后长期卧床具致使的威胁，因此在治疗上如无禁忌应争取早期手术，早期下床活动。（4）在治疗骨折的同时，应注意对骨质疏松症的治疗，这对减轻全身骨痛，促进骨折愈合，防止再骨折均有重要意义。

Clinical analysis of 156 old patients with hip fracture

Objective To evaluate the treatment of hip bone fracture in the senile patients,and analyse its characteristics and key points in diagnosis and treatment Methods All 156 cases over 60 years old (age ranging from 60 to 93) with hip fracture were treated from January 1997 to December 1999 There were 55 males with a meam age of 71 8 years and 101 female with a mean age of 73 1 years The types of bone fracture included femoral neck fracture (94 cases, 20 males and 74 female), femoral intertrochanteric fracture 62 cases, 35 male and 27 female 41 cases were treated by non operative methods;115 patients received operative treatment,among whom 45 underwent internal fixation, 68 replacement of artificial femoral head, and 2 resection of femoral head and neck Some patients were given antiosteoporotic drugs Results 110 cases were followed up for 0 5 to 3 5 years Two cases had venous thrombosis in low limbs after operation, 2 cases had femoral head ischemia and necrosis, 2 cases loosened and slipping internal fixation, 1 case break of internal fixation, 4 cases suffered pain caused by artificial femoral head sinking, and 2 cases died shortly after operation (dead of myocardiac infarction and respiratory tract infection) 97 cases got satisfactory results (88 2%) Conclusion (1)Hip bone fractures are mostly seen in elderly women (64 7%), while less in elderly men (35 3%),which is related to the osteoporosis after menopause in females Femoral neck fractures are mostly seen in senile females, while femoral intertrochanteric fractures are mostly seen in senile males After 70 years of age,the hip bone fracture occurs more frequently than before, which is related to the osteoporosis, suggesting that the occurrence rate and risk of bone fracture increase with the age (2) The hip bone fracture in the elderly is attributed to osteoporosis,but the femoral intertrochanteric fracture generally has a history of injury The femoral neck fracture is often caused by a slight force (torsion),so we should make a right diagnosis and try to prevent omissed diagnosis or misdiagnosis,which will have negative effect (3) Since old patients often suffer from cardiovascular disease or respiratory disease, being bed for a long periold is deadly dangerous If there is no contraindication, operation should be performed as early as possible,and exercises should be done early after leaving bed (4) We should treat the osteoporosis together with fracture,which is of great significance in relieving bone pain,promoting bone healing and preventing hip bone from fracture again