老年股骨粗隆间骨折的手术治疗.doc

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1、老年股骨粗隆间骨折的手术治疗【摘要】目的探讨老年股骨粗隆间骨折的治疗方法及效果。方法2000年1月至2005年1月，治疗160例老年股骨粗隆间骨折患者，平均年龄78岁，95％合并内科疾病。其中保守治疗8例，切开复位内固定术116例(DHS治疗60例，PFN治疗56例)，人工关节置换36例。结果所有患者均获得12～24个月的随访，保守治疗及切开复位内固定组骨折均愈合，无不愈合及死亡病例。人工关节组无术后早期脱位、人工假体下沉、断裂、松动等并发症发生。所有患者日常生活能自理，无严重疼痛、功能障碍，疗效满意。按Harris评分标准，优良率保守治疗组为70％，DHS组90％，PFN

2、组87.5％，人工关节组92.3％。结论对老年股骨粗隆间骨折，应积极进行手术治疗，充分术前准备，根据患者的健康状况及骨折类型选择适合不同患者的治疗方法，减少骨折并发症的发生，提高老年人的生活质量。【关键词】股骨粗隆间骨折股骨近端髓内钉动力髋螺钉内固定术人工关节置换术OperativeTreatmentofOldagePatientswithIntertrochantericFractureAbstract：ObjectiveTodiscussthemethodandclinicalresultsofoldagepatientswithintertrochantericf

3、ractures.MethodsFromJanuary2000toJanuary2005，160caseswithintertrochantericfracturesweretreatedinourdepartment.Theaverageageofthepatientswas78yearsold，95％ofthemsufferedfromcomplicatedmedicaldisease.8ofthemweretreatedwithconservativetraction，116ofthemweretreatedwithinternalfixation(60withdyn

4、amichipscrews，56withproximalfemoralnail)，and36ofthemweretreatedwithartificialjoint.ResultsAllthepatientswerefollowedupfor12to24months.Allthefractureshealedandnoonediedinconservativeandinternalfixationgroup.Therewasnoearlierperioddislocation，sinkingorsofteningandbreakingofprosthesisinartifi

5、caljointgroup.Allofthepatientscouldtakecareofdailylifebythemselvesandweresatisfiedwiththeoutcome.Noseriouspainordysfunctionwerefoundinthepatients.AccordingtoHarrisscoresystem，theexcellentandgoodrateis70％inconservativegroup，90％inDHSgroup，87.5％inDHSgroup，and92.3％inartificialjointgrouprespect

6、ively.ConclusionOperativetreatmentshouldbeperformedinoldagepatientswithintertrochantericfracturesactively.Thepreoperativepreparationshouldbedonesufficiently.Propermethodshouldbedeterminedonthebasisofphysicalconditionsandfracturetypesofthedifferentpatients.Thefinaltherapeuticobjectiveistod

7、ecreasecomplicationsoffractureandimprovethequalityoflifeoftheoldpeople.5Keywords：intertrochantericfracture；proximalfemoralnail；dynamichipscrews；internalfixation；artificialjointreplacement老年股骨粗隆间骨折患者常伴有骨质疏松症，且并存各种疾病，使用保守疗法，2～3个月的卧床牵引虽然在部分病例中能达到愈合目的，但易引起心肺功能下降、褥