不同方法治疗老年性股骨粗隆间骨折的临床分析

目的 探讨不同方法治疗老年性股骨粗隆问骨折安全有效的内固定方法、临床效果及其临床适应证.方法 对58例老年性股骨粗隆间骨折分别采用股骨近端解剖型锁定钢板固定14例,动力髋螺钉(DHS)固定24例,股骨近端解剖型钢板固定20例,比较3组术中失血量、手术时间、骨质劈裂情况及骨折愈合时间,随访Sanders评分结果和并发症发生情况,并进行临床和统计学分析.结果 术后全部得到随访,随访8个月～3年,平均1.5年,3组术式的优良率分别为92.9%、92%和90%.结论 不同方法治疗老年性股骨粗隆间骨折的临床效果都很满意,但各有其适应证,手术方式应根据骨折类型、年龄、体质因素及患者骨质疏松程度,结合各内固定特点选择最佳治疗方案,对伴有严重骨质疏松的高龄患者适合选用应用解剖型锁定钩板(ALHP)固定,对Evans Ⅰ、Ⅱ型和部分EvansⅢ型适合选用DHS固定,对Ⅳ、Ⅴ型适合选用股骨近端解剖型钢板固定.

Different methods treatment for intertrochanter fracture of femur

Objective Probe into different method safe and effective fixation method,clinical result and cliniical to indications of different treatments in intertrochanter fracture of femur in the old elderly.Methods Adopting the femur near end dissecting type to lock the stencil plate fixation 14 of 58 cases of old intertrochanter fracture of femur separately.the hip screw of motive force(DHS) fixation was used in 24,femur near end stencil plate fixation in 20,and the blood loss,operation time,ossicle split off situation and fracture heal time were compared among the three groups.Sanders grade results and complications were followed up.Results Postoperative follow up Was done in all patients,from 8 months to 3 years,averaged 1.5 years.three groups of skill type fine rate of the three groups being 92.9%,92%,90%respectively.Conclusions Different methods showed good clinical results in treating the old intertrochanter fracture of femur,each having its indications.Operation should be done should follow based on fracture type,age,physique factors and patient's osteoporosis intensity,choosing the best healing solution by characteristics of intermal flxation while each combining.The hook board(ALHP)is suitable for old patients with serious osteoporosis,DHS for Evans Ⅰ,Ⅱ types and some Evans Ⅲ type,and femur near end dissecting type stencil plate for Ⅳ and Ⅴ types fractures.