| 高龄股骨粗隆间骨折治疗方法的选择 |
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Received:April 12, 2004
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| 作者 | Author | 单位 | Unit | E-Mail |
| 唐吉平 |
TANG Ji-ping |
深圳市罗湖区中医院骨科,广东深圳518001 |
Department of Orthopaedics,Luohu Hospital of Traditional Chinese Medicine of Shenzhen,Shenzhen 518001,Guangdong,China |
drtangs@163.com |
| 蒋顺琬 |
JIANG Shun-wan |
深圳市罗湖区中医院骨科,广东深圳518001 |
Department of Orthopaedics,Luohu Hospital of Traditional Chinese Medicine of Shenzhen,Shenzhen 518001,Guangdong,China |
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| 曾强 |
ZENG Qiang |
深圳市罗湖区中医院骨科,广东深圳518001 |
Department of Orthopaedics,Luohu Hospital of Traditional Chinese Medicine of Shenzhen,Shenzhen 518001,Guangdong,China |
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| 罗强 |
LUO Qiang |
成都第一骨科医院 |
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| 期刊信息：《中国骨伤》2006年19卷，第2期，第67-69页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
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目的:探讨治疗高龄股骨粗隆间骨折的方法选择。
方法:1997年6月-2003年5月治疗高龄股骨粗隆间骨折115例,男48例,女67例;年龄62~90岁,平均76.1岁。按Evan分型:Ⅰ型22例,Ⅱ型24例,Ⅲ型34例,Ⅳ型27例,Ⅴ型8例。采用骨牵引15例,多枚折尾钉固定32例,动力髋螺钉内固定47例。
结果:经12~34个月（平均22个月）的随访,共有94例获完整随访资料。所有病例均骨折愈合,依据疗效标准:骨牵引组（A组）优2例,良6例,可5例,差2例;多枚折尾钉组（B组）优11例,良17例,可4例;动力髋螺钉组（C组）优18例,良22例,可6例,差1例。A组优良率明显低于B组（χ2=4.881）和C组（χ2=4.875）,差异有显著性意义（P<0.05）;B组和C组疗效差异无显著性（χ2=0.352,P>0.05）;功能恢复时间A组长于B组（F=213.422）和C组（F=260.809）,有显著性差异（P<0.05）,B、C组间无显著性差异（F=1.427,P>0.05）;A、B、C三组分别有6、2和4例发生髋内翻,A组显著高于B、C两组（χ2=6.020,6.170,P<0.05）,B、C两组间无显著性差异（χ2=0,P>0.05）。
结论:及时有效的内固定是治疗高龄股骨粗隆间骨折的基本原则。EvanⅠ、Ⅱ型骨折以多枚折尾钉内固定为首选,EvanⅢ、Ⅳ、Ⅴ型（逆粗隆间骨折）以动力髋螺钉为最佳,骨牵引治疗效果明显低于内固定者。 |
| [关键词]:转子间骨折 牵引术 骨折固定术,内 |
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| The selection of therapeutical methods for treating intertrochanteric fracture of femur in aged patients |
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Abstract:
Objective:To investigate the selection of therapeutical methods for treating the intertrochanteric fracture of femur in aged patients.
Methods:From June 1997 to May 2003,115 aged patients（48 male and 67 female with average age of 76.1 years ranging from 62 to 90 years）with intertrochanter fracture of femur were treated.According to Evans classification:22,24,34,27 and 8 cases were classified into type Ⅰ,type Ⅱ,type Ⅲ,type Ⅳ and type Ⅴ of intertrochanter fracture of femur respectively.Fifteen patients were treated by bone traction,32 patients by fixation with several broken caudal screws and 47 patients by internal fixation with the dynamic hip screw （DHS） respectively.
Results:After following up for 12 to 34 months（average 22 months）,the complete data were collected in 94 patients.All the patients were healed.According to the standard for evaluation of curative effect,in group A treated by bone traction the results were excellent in 2 cases,good in 6 cases,fair in 5 cases and poor in 2 cases;in group B treated by broken caudal,they were excellent in 11 cases,good in 17 cases and fair in 4 cases;while in group C treated by DHS,the results were excellent in 18 cases,good in 22 cases,fair in 6 cases and poor in 1 cases.The rate of excellent and good in group A was significantly lower than group B（χ2=4.875）and C（χ2=4.881）（P<0.05 respectively）.There were no significant difference between group B and C（χ2=0.352,P>0.05）.The time course of functional recovery in group A was significantly longer than group B（F=213.422,P<0.05）and C（F=260.809,P<0.05）.No significant difference was found between group B and C（F=1.427,P>0.05）.The hip inversion occurred in 6 cases in group A,2 in group B and 4 in group C respectively.Clearly the incidences of the hip inversion in group A was obviously higher than group B（χ2=6.020,P<0.05） and C （6.170,P<0.05）.There was no significant difference between group B and C（χ2=0,P>0.05）.
Conclusion:Betimes internal fixation was the basic principle for treating the intertrochanteric fracture of femur in aged patients.The best way for treating patients with type Ⅰ and Ⅱ of intertrochanteric fracture of femur is fixation with several broken caudal screws.For the treatment of type Ⅲ,Ⅳ and Ⅴ of intertrochanteric fracture of femur the DHS fixation is best one.The curative effect of internal fixation is better than that achieved by bone traction. |
| KEYWORDS:Intertrochanteric fracture Traction Fracture fixation,internal |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 唐吉平,蒋顺琬,曾强,罗强.高龄股骨粗隆间骨折治疗方法的选择[J].中国骨伤,2006,19(2):67~69 |
| 英文格式: | TANG Ji-ping,JIANG Shun-wan,ZENG Qiang,LUO Qiang.The selection of therapeutical methods for treating intertrochanteric fracture of femur in aged patients[J].zhongguo gu shang / China J Orthop Trauma ,2006,19(2):67~69 |
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