老年人髋部骨折的手术治疗策略探讨

目的探讨老年人髋部骨折手术治疗策略、临床应用方法及疗效。方法手术治疗248例老年髋部骨折患者,其中人工髋关节置换治疗114例,内固定治疗134例,按照末次随访患肢髋关节Harris评分及X线片评估疗效。结果 226例获得随访,时间5-76（36.8±14.6）个月。术中无死亡。关节置换者术后有4例脱位,经手法复位皮牵引固定未再脱位;1例术后4年髋臼松动重新置换。内固定治疗者骨折均愈合,无内置物松动、断裂、骨不连发生,并发髋内翻28例,其中螺钉切破股骨头4例,取出内固定行关节置换术后功能恢复。末次随访时226例患肢髋关节Harris评分为72-96（87.7±7.9）分,其中优111例,良84例,可22例,差9例,优良率为86.3%。结论老年髋部骨折患者积极正确的手术治疗可促进早期活动,减少并发症和病死率,提高生活质量。

Treatment strategy in elderly patients with hip fracture surgery

Objective To discuss the treatment strategy,clinical application method and curative effect of the hip fracture in aged patients.Methods 248 patients were treated with hip fracture,including 114 cases hip replacement,and 134 internal fixation.The treatment outcomes were assessed according to the final follow-up limb hip Harris criteria and plain X-ray film.Results 226 cases were followed up for 5~76（36.8±14.6） months.No one died during the operations.4 cases got dislocation after joint replacement group and no dislocation after manipulative replacement and skin-tracted fixation：1 case after four years of acetabular loosening to have re-replacement.Internal fixation group was healed,no complication such as loosening of internal fixation,breakage of internal fixation and non-union of bone.Exept 28 cases had hip varus,of which the screw cutting through the femoral head in four.The joint function was restroed after hip replacement surgey alternatively.The final follow-up limb hip Harris score was 72~96（87.7±7.9）：111 excellent,84 good,22 fair,9 poor.The excellent and good rates were 86.3%.Conclusions Positive surgery can promote early activity and reduce the complications and mortality,improve life quality,which is an ideal method for the elderly patients with hip fracture.