高龄骨质疏松性股骨转子问骨折的治疗

目的探讨高龄股骨转子间骨折合并骨质疏松的特点、手术适应证、并发症及治疗效果。方法回顾分析1996年10月至2007年12月手术治疗的80岁以上高龄骨质疏松性股骨转子间骨折187例（193髋），对骨折的手术治疗、术后并发症、所伴骨质疏松治疗等方面进行了分析。结果187例患者，年龄80—96岁，平均85岁。骨折类型：按Evan’s骨折分类，Ⅰ～Ⅳ型分别为17、47、68、61例。其中174例患有不同程度的内科疾病（占93％）。手术方法：动力髋螺钉81髋、DHS＋环抱钢板20髋、Gamma钉22髋、股骨近端钉44髋、短股骨重建钉26髋。平均手术时间75min，术中输血65例，输血量400～1200ml，平均输血230ml。术中及术后并发症包括心血管、脑梗塞、肺部感染及急性呼吸衰竭等。术后予抗骨质疏松治疗。术后6个月163例获得随访，功能评定优66例、良73例、优良率为84％。159例骨折愈合（93．6％）。结论高龄股骨转子间骨折的发病率高，所伴骨质疏松明显。治疗需充分评估及治疗术前严重疾病；手术治疗能减少因长期卧床引起的并发症、降低致残及致死率，提高生活质量；围手术期必须进行抗骨质疏松治疗。

Surgical treatment of osteoporotic peri-intertrochanteric fracture in elderly patients

Objective To study the characteristics, operative indications, complications and treatment results of osteoporotic intertrochanteric fractures of femur in elderly patients. Methods A total of 187 patients （193 hips） aged over 80 years were treated between October 1996 and December 2007. The operative technique, post-operative complication, and the treatment for accompanied osteoporosis were retrospectively analyzed. Results The average age of the patients was 85 years old （ranging from 80 to 96）. Evan＇s classification： type Ⅰ（n=17）, type Ⅱ （n=47）, type Ⅲ（n=68）, type Ⅳ（n=61）. Of all, 174 cases had different medical diseases （93%）. Treatment methods included DHS （81 hips）, DHS＋TSP （20 hips）, Gamma nail （22 hips）, PFN （44 hips）, and reconstructive nail （26 hips）. The mean operation time was 75 minutes. 65 patients needed blood transfusion during the operation, the average transfusion was 230 （ranged from 400 to 1200） ml. The complications included acute heart failure, cerebral thrombosis, lung infection, and acute respiratory failure, etc. Anti-osteoporosis treatment were performed after operations. 163 cases were followedup in 6 months after operation, 84% of which got excellent or good results. 159 fractures healed （93.6%）. Conclusions The incidence of intertrochanteric fracture is high in elderly, always accompanied with osteoporosis. The evaluation is critical and the complications should be controlled before operation. Surgical treatment can reduce the incidence of complications causing by long-term bed as well as morbidity and disability, and improve quality of life. Antiosteoporosis is requisite during and after operation.