外固定支架治疗股骨粗隆间骨质疏松骨折11例报告

目的探讨不能耐受内固定手术的股骨粗隆间骨质疏松骨折的骨外固定治疗的可行性。方法1998～2008年伴有严重疾病的老年股骨粗隆间骨质疏松骨折11例，男4例，女7例；年龄69岁～94岁（平均80．6岁）。所有患者闭合复位，头颈内交叉穿针，股骨近段穿入2枚螺纹半针，组合成不规则四边形固定框的固定形式。结果除1例合并白血病患者术后5个月死亡外，其余10例患者骨折均在12—17周（平均14周）内愈合。随访3个月-2年，平均9．6个月。术后针道感染3例，占27．3％（3／11），其中、单针针道感染1例，多针道感染2例，无不可控性针道感染，亦无脱针、断针、头切割等现象。结论骨外固定术，具有创伤小、出血少、操作简单；手术风险小，可局麻下手术等优点。而模拟骨小梁走向的交叉穿针方式，又提高了骨外固定器对骨质疏松骨的把持力，提高了外固定架固定的可靠性。所以，骨外固定术扩大了无法接受内固定手术的股骨粗隆间骨质疏松骨折患者的手术适应证，改善了此类患者伤后生存质量。

External fixation for osteoporotic intertrochanteric fractures: a report of 11 cases

Objective To investigate the feasibility of external fixation for intertroehanteric fractures in osteoporotic patients who cannot endure internal fixation. Methods Eleven senile patients who had osteoporotie intertrochanteric fracture accompanied with severe diseases were treated between 1998 and 2008. They were 4 men and 7 women, aged from 69 to 94 with the average of 80.6. All patients underwent close reduction. Crossed pin fixation was performed in the femoral head and femoral neck. Two semi-spiral pins were inserted into the proximal femur, and formed irregular quadranglular frame. Results Except for 1 patient who also had leukemia died 5 months after surgery, other 10 patients reported the healing of fracture 12 to 17 weeks after surgery, 14 weeks in average. The patients were followed up for 3 to 24 months, 9.6 months in average. Three patients sustained pin-track infections, accounting for 27.3% of the total. Among them, 1 had single pin-track infection, and 2 had multiple pin-track infection. There was no presence of uncontrollable pin-track infections, broken pin, fallen pins or head cut, etc. Conclusions External fixation has the advantages of small trauma, less bleeding, easy operation, lower risk, and the feasibility of local anesthesia, etc. The method of interseetional pinning enhances the pullout strength on the ostenporotic bones and strengthens the reliability of the external fixation. Thus, external fixation expands the scope of indications for intertrochanteric fractures in osteoporotic patients who cannot endure internal fixation and improve their life quality.