| 老年转子间骨折的内固定选择及并发症预防 |
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Received:December 25, 2008
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| 作者 | Author | 单位 | Unit | E-Mail |
| 葛新 |
GE Xin |
上海市江湾医院骨科,上海 200434 |
Department of Orthopaedics,Shanghai Jiangwan Hospital,Shanghai 200434,China |
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| 张建明 |
ZHANG Jian-ming |
上海市江湾医院骨科,上海 200434 |
Department of Orthopaedics,Shanghai Jiangwan Hospital,Shanghai 200434,China |
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| 陆伟成 |
LU Wei-cheng |
上海市江湾医院骨科,上海 200434 |
Department of Orthopaedics,Shanghai Jiangwan Hospital,Shanghai 200434,China |
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| 邱水强 |
QIU Shui-qiang |
上海市江湾医院骨科,上海 200434 |
Department of Orthopaedics,Shanghai Jiangwan Hospital,Shanghai 200434,China |
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| 期刊信息：《中国骨伤》2009年22卷，第5期，第385-386页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
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目的：比较分析采用不同内固定方法治疗老年转子间骨折，并探讨术后发生并发症的原因及预防措施。
方法：1997年1月至2007年12月手术治疗102例老年转子间骨折，男46例，女56例；年龄60～93岁，平均76. 5岁。稳定型34例，不稳定型68例。采用内固定手术治疗，其中动力髋螺钉(DHS)固定82例，近端交锁钉(PFN)固定5例，多枚钉(空心螺纹钉或斯氏钉)固定9例，动力性髁螺钉(DCS)固定6例。
结果：102例随访6～72个月，平均36个月。骨折愈合时间8～12周。依据疗效评价标准，术后功能恢复优72例，良20例，差10例。其中髋内翻3例，钉子突出股骨头2例，内固定螺钉断裂1例，股骨头缺血性坏死2例，术后感染1例，骨折延迟愈合1例，术后诱发原合并症9例。
结论：对老年不稳定型骨折的治疗应针对不同的骨折类型及患者的全身情况，选择术者熟悉的内固定方法，DHS是治疗的常用方法。对逆转子骨折或伴严重骨质疏松症则采用PFN治疗。对全身情况较差，不能耐受较大手术的Ⅰ、Ⅱ型转子间骨折，才考虑采用加压镙纹钉内固定。 |
| [关键词]:转子间骨折 老年人 骨折固定术,内 手术后并发症 |
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| Selection of the internal fixation for various types of intertrochanteric fracture in aged patients and prevention for complication |
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Abstract:
Objective: To investigate the results and indication of differently internal fixation for intertrochanteric fracture and prevent for complication.
Methods: One hundred and two patients of intertrochanteric fracture of femur from January 1997 to December 2007 were reviewed and analysed. There were 46 males and 56 females,with an average age of 76.5 years ranging from 60 to 93 years. There were 34 cases of stability fractures and 68 of instability fractures. The methods of internal fixation included dynamic hip screw in 82 cases, proximal interlocking nail in 5,multi-screw fixation in 9,dynamic codylar screw in 6.
Results: These patients were followed up for 6 to 72 months(36 months in average). The time of fracture healing was from 8 to 12 weeks. According to evaluation criterion of effect,the results were excellent in 72 cases,good in 20,fair in 10. After operation,there were 3 cases of coax vara,2 cases of lag screws cutting out,1 case of breakage of screw,2 cases of avascular necrosis of the femoral head,1 case of postoperative infection,1 case of delayed union.
Conclusion: Suitable implant selection according the type of fracture,health condition is an important factor to reduce the incidence of complication for unstable fracture in aged patients. DHS is a main treatment of intertrochanteric fracture. PFN is recommended for serious osteoporosis or unstable intertrochanteric fracture. Compression screws is a choice for the fixation of typeⅠand typeⅡ fracture of bad health condition. |
| KEYWORDS:Intertrochanteric fractures Aged Fracture fixation,internal Postoperative complications |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 葛新,张建明,陆伟成,邱水强.老年转子间骨折的内固定选择及并发症预防[J].中国骨伤,2009,22(5):385~386 |
| 英文格式: | GE Xin,ZHANG Jian-ming,LU Wei-cheng,QIU Shui-qiang.Selection of the internal fixation for various types of intertrochanteric fracture in aged patients and prevention for complication[J].zhongguo gu shang / China J Orthop Trauma ,2009,22(5):385~386 |
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