老年不稳定型股骨转子间骨折的内固定选择

[目的]探讨不稳定型老年转子间骨折的内固定方法.[方法]对2003年6月～ 2008年9月手术治疗的79例不稳定型老年转子间骨折(Evan’s Ⅰ3-4型)进行回顾性分析,按手术方式分为髓内固定组(采用PFN和PFNA)和髓外固定组(DHS),统计骨折类型、手术时间、术中出血量、骨折愈合时间、骨折愈合率、优良率、并发症发生例数和发生率(死亡、伤口延迟愈合、伤口感染、髋内翻、股骨头坏死).[结果]79例患者全部获得随访(13～36个月),平均15.5个月.年龄65～99岁,平均75岁.49例采用DHS,30例采用髓内固定(采用PFN和PFNA),DHS组(Evn's Ⅰ3型35例,Evan's Ⅰ4型14例,手术时间60～110 min,术中出血量100～300 ml,骨折愈合时间3～8个月,愈合45例,愈合率91.8％,并发症(死亡3例、伤口延迟愈合3例、伤口感染1例、髋内翻6例、股骨头坏死2例),按照Harris功能评分,优22例,良18例,优良率78.9％.髓内固定组:Evan'sⅠ3型21例,Evan's Ⅰ型9例,手术时间60～150 min,术中出血量60～250 ml,骨折愈合时间3～6个月,愈合29例,愈合率96.5％,按照Harris功能评分,优11例,良15例.优良率80.01％.并发症:死亡1例、髋内翻3例、股骨头坏死1例.[结论]对于老年不稳定型转子间骨折的内固定治疗,髓内固定较DHS有一定的优势,但对于严重骨质疏松的患者,两者均存在不足.针对这类病人,内固定方式还存在改进的空间和必要.

Internal fixation selection in unstable intertrochanteric fracture in the elderly

[Objective] To discuss the treatment of special type of serious osteoporosis intertrochanteric fracture in the elderly.[Method] From June 2003 to September 2008,79 cases of unstable intertrochanteric fracture in the elderly were reviewed retrospectively,including Evan’s I3 to Evan’s I4,with an average age of 75 years(range,65-99 years).[Result]All cases received internal fixation,including DHS in 49 cases,PFN or PFNA in 30 cases.The follow-up period ranged from 13 to 36 months(average,15.6 months).One patient died in hospital,2 died in follow up period.In DHS group,there were Evan’s type I3 in 35 cases,Evan’s type I4 in 14 cases.Time for operatin was 60-110 minutes,with blood loss of 100-300ml.Fracture union time was 3-8 months.Fracture union was achieved in 45 cases,with the union rate of 91.8%.Complications included death in 3 cases,wound infection in 1 case,varus in 6 cases,femoral head necrosis in 2 cases.The excellent Harris score result was achieved in 22 cases,good in 18 cases.The excellent and good results rate was 79.59%.In intramedullary fixation group,there were Evan’s type I3 in 21 cases,Evan’s type I4 in 9 cases.Time for operation was 60-150 minutes,with blood loss of 60-250 ml.Fracture union was achieved in 29 cases,with union time of 3-6 months,with union rate of 96.5%.Complications included death in 1 case,varus in 3 cases,necrosis in 1 case.Excellent Harris score was achieved in 11 cases,good in 15 cases,with excellent and good results rate of 86.70%.[Conclusion] For unstable intertrochanteric fracture in the elderly,intramedullary fixation is preferred than the DHS,but both two methods are not adequate for the serious osteoporosis cases.It is needed to promote the fixation.