合并帕金森病股骨转子间骨折的手术治疗

背景：目前国内外对合并帕金森病的股骨转子间骨折的手术治疗报道较少，缺乏相关的临床诊治经验。目的：探讨对合并帕金森病的股骨转子间骨折患者进行手术治疗的特点及围手术期处理。方法：回顾分析2004年2月至2013年2月我院收治的股骨转子间骨折合并帕金森病的14例患者的临床资料，其中Jen．sen．EvansIII型3例，Ⅳ型6例，V型5例。男4例，女10例；手术时年龄66～92岁，平均78．2岁。6例行滑动加压动力髋螺钉固定（含2例TSP接骨板），8例行髓内固定系统固定。根据Harris评分系统对所有患者进行术前和术后随访功能评定。结果：5例患者在术后1年内因肺部感染和心力衰竭死亡；9例完成随访，随访时间3～60个月，平均28．7个月。Harris评分由术前20．2分（16～26分）改善至末次随访时76-3分（62～85分）。所有随访患者在术后3个月内骨折基本愈合，未出现切口感染、髋内翻畸形、拉力螺钉切出股骨头及术后再骨折等并发症。结论：对于合并帕金森病的股骨转子间骨折患者，如果手术方式和内固定种类选择适当，并注意围手术期并发症防治，可以取得较好的临床疗效。但由于帕金森病对术后恢复影响较大，此类患者预后差于单纯髋部骨折患者。

Surgical treatment of intertrochanteric fracture in patients with Parkinson disease

Background： Currently, there are few reports about surgical treatment of intertrochanteric fracture combined with Parkinson disease. Objective： To explore the surgical characteristics and perioperative management of intertrochanteric fracture in the patients with Parkinson disease. Methods： A retrospective study was performed on 14 intertrochanteric fracture patients who had suffered from Parkinson disease. There were 4 males and 10 females with an mean age of 78.2 years （range, 66-92 years）. By Jensen-Evans classifi- cation, 3 cases in type III, 6 cases in type IV, 5 cases in type V. Dynamic hip screw （DHS） system was used in 6 cases and intramedullary nail system was used in 8 cases. Results： Five patients died within 1 year after operation due to lung infection and heart failure. Nine patients were followed- up successfully for 28.7 months on average. Postoperative Harris score of the 9 patients was signicantly higher than preoper- ative one （76.3 vs 20.2）. No severe complications such as incision infection, hip varus, screw cut-out and refracture were found during follow-up. Conclusions： Good curative effect will be achieved if we choose appropriate surgical treatment, implants, proper periopera- tive period management and prevention of complications for intertrochanteric fracture in patients with Parkinson disease, who always have a poor prognosis compared with other hip fracture patients.