老年股骨粗隆下骨折的手术治疗

目的：探讨老年股骨粗隆下骨折的手术治疗方法。方法：自2003年12月～2008年3月，对34例老年股骨粗隆下骨折患者采用闭合复位、DCS内固定治疗，男16例，女18例，年龄75～96岁，平均81．2岁。合并内科疾病33例，占97．1％，合并两种以上疾病患者21例，占61．8％。手术前请内科会诊协助诊治内科疾患，约5～10天后手术，术后常规进行个体化康复和骨质疏松的治疗。结果：所有病例随访9～36月，平均17个月，未发生心脑肝肺并发症，均骨性愈合，无钢板松动、断裂、骨不连等并发症。2例出现轻度髋内翻，根据HSS髋关节评分法评定功能，优14例，良16例，可4例。优良率88．2％。结论：积极处理内科疾病、个体化康复训练、积极治疗骨质疏松以及牢固的固定是治疗老年股骨粗隆下骨折的关键。

Surgical Treatment for the Elderly Subtrochanteric Fracture

Objective： To investigate the treatment method of elderly subtrochanteric fracture. Methods： From December 2003 to March 2008, 34 patients with subtrochanteric fracture were treated with dynamic condylar screw. There are 16 male and 18 female with an average age of 81.2 years（ranging from 75 to 96 years）, 33 cases （97.1%）combined with medical illness before operation. Preoparative preparation was 5-10 days, internal medicine doctor was invited to diagnose and cure the medical illness. Individual healing exer- cise and active treatment to osteoporosis were carried through after operation. Results： The follow-up period was 9-36 months, with an average time of 17 months. None of heart, brain, liver or lung complications happened in this group. All fractures healed without complications. Light coxa vara was noted in 2 cases. The function of hips was excellent in 14 cases, good in 16 cases and fair in 4 cases according to HSS＇s scores. The excellent and good rate was 88.2%. Conclusion： Active treatment, individual healing exercise and ideal fixation are the key to treat the elderly subtrochanteric fracture.