老年骨质疏松性股骨粗隆间骨折的治疗经验

Intertrochanteric femoral fractures in elderly patients with dynamic hip screw and hemiarthroplasty

摘要:

目的 回顾性分析应用人工股骨头置换及动力髋螺钉系统（dynamic hip screw, DHS）治疗老年骨质疏松性粗隆间骨折，总结该类患者治疗经验。方法 选取第四军医大学西京医院骨科2007年1月至2009年12月老年骨质疏松性粗隆间骨折病例103例，其中采用DHS术式71例；采用人工关节置换32例；记录手术时间、术中出血量，术后并发症，骨折愈合情况，术后髋关节Harris功能评分。结果 DHS组平均手术时间（96.7±8.6）min，平均出血量（317.7±26.5）ml，术后Harris髋关节功能评分，优32例，良26例，可6例，差7例，优良率81.7%；人工股骨头置换组手术时间平均（107.0±12.8）min，手术出血量平均（335.3±28.1）ml，术后Harris髋关节功能评分：优10例，良14例，可2例，差1例，优良率88.9%。结论 结合抗骨质疏松治疗，只要适应证选择恰当，DHS及人工股骨头置换均为老年骨质疏松性粗隆间骨折的有效治疗手段，中短期疗效满意。

Abstract:

Objective To evaluate the clinical effects and indications of dynamic hip screw (DHS) and hemiarthroplasty in the treatment of intertrochanteric femoral fracture in the elderly patients. Methods We retrospectively reviewed the clinical data of 103 elderly patients diagnosed as intertrochanteric femoral fractures between January 2007 and December 2009 in our hospital. The DHS system was used in 71 patients, and hemiarthroplasty was used to treat the other 32 patients. The clinical data including operation time, blood loss volume, post-operative complications, fracture healing and function recovery were recorded and analyzed. Results In the DHS group, the mean operation time was (96.7±8.6)min; the mean blood loss volume was (317.7±26.5)ml. Harris￠s hip function was excellent in 32 cases, good in 26 cases, moderate in 6 cases, and poor in 7 cases, with satisfaction rate of 81.7%. In the hemiarthroplasty group, the mean operation time was (107.0±12.8)min; the mean blood loss volume was (335.3±28.1)ml. Harris￠s hip function was excellent in 10 cases, good in 14 cases, moderate in 2 case, and poor in 1 case, with satisfaction rate of 88.9%. Conclusions Both DHS and hemiarthroplasty are effective in the management for the intertrochanteric femoral fracture in the elderly patients, if combined with anti-osteoporosis treatment and suitable indications. The short and middle-term outcome are both satisfactory.