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1、临床骨科杂志JournalofClinicalOrthopaedics2009Jun;12(3)·319··临床论著·高龄股骨转子间骨折手术治疗以及围手术期并发症12122郑建平,杨丰建,傅格深,沈海敏,张云海摘要:目的探讨不同手术方式治疗高龄股骨转子间骨折的特点以及围手术期并发症的处理方法。方法将83例高龄股骨转子间骨折患者按治疗方法分为3组:滑动时鹅头钉(DHS)内固定组27例,股骨近端髓内钉(PFN)内固定组42例,人工关节(股骨头置换)组14例。比较手术时间、术中和术后出血、术后髋关节功能以及围手术期并发症。结果78例获
2、得随访,时间3～12个月。围手术期并发症:人工关节组、PFN组明显优于DHS组(P<0101)。手术时间、术中和术后失血量:PFN组优于DHS组和人工关节组(P<0101)。术后髋关节功能人工关节组最早得到恢复;术后6～12个月,3种手术方式比较,差异无显著性(P>0105)。结论高龄股骨转子间骨折的围手术期并发症需要谨慎处理,手术方式以PFN内固定最有优势。关键词:老年人;股骨骨折;骨折固定术;围手术期并发症中图分类号:R638142;R68713文献标识码:A文章编号:1008-0287(2009)03-0319-03Tre
3、atmentofelderlyfemoralintertrochantericfractureandperioperativecomplicationsZHENGJian2ping,YANGFeng2jian,FUGe2shen,SHENHai2min,ZHANGYun2hai(DeptofOr2thopaedics,QuzhouTraditionalChineseMedicineHospital,Quzhou,Zhejiang324002,China)Abstract:ObjectiveToassessthetherapeut
4、iceffectsofthreekindsofsurgeriesforelderlyintertrochantericfrac2tureandperioperativecomplications.Methods83elderlycaseswithfemoralintertrochantericfractureswereran2domlydividedinto3groups.27casesweretreatedwithDHS,42withPFNand14withfemoralheadreplacement.Theoperation
5、durations,bloodlossinoperationandpostoperation,andHarrisscoresofhipjointswerecompared.Results78caseswerefollowedupfor3～12months.Differenceofperioperativecomplicationsbetweenfemoralheadreplacementgroup,PFNgroupandDHSgroupwassignificant(P<0101).Complicationsinfemoralhe
6、adre2placementgroupandPFNgroupweremuchlowerthanthatinDHSgroup.Differencesofoperationduration,bloodlossinoperationandpostoperationinPFNgroupweresignificant(P<0101).Operationduration,bloodlossinoper2ationandpostoperationinPFNgroupweremuchlessthanthoseintheothergroups.H
7、ipjointfunctionisreconstruc2tedmuchearlierinfemoralheadreplacementgroup,buttheHarrisscoresdifferenceswerenotsignificantamongdif2ferentgroupsafter6monthspostoperation.ConclusionsPerioperativecomplicationsinelderlypatientsfemoralin2tertrochantericfracturearevitalandsho
8、uldbecautious.PFNinternalfixationtreatmentisrecommended.Keywords:aged;femoralfractures;fracturefixation;in2hospitalcomplications对于高
