【摘要】 目的:探讨帕金森病患者股骨转子间骨折的临床特点,评价其手术治疗的临床疗效。方法:回顾性分析21例帕金森病股骨转子间骨折病例,记为观察组;在同期治疗的无帕金森病的股骨转子间骨折患者中,为每例帕金森病股骨转子间骨折患者配对一位患者作为对照组。比较两组患者手术时间、术中出血量、ICU停留时间、住院时间、术后相关的并发症及Harris评分。结果:①两组手术时间以及术中出血量的差异无统计学意义(t=1.359,P=0.191;t=1.792,P=0.101),但观察组ICU停留时间和住院时间明显较对照组长(t=30350,P=0.006;t=2.993,P=0.012)。②观察组共发生并发症12例(57.1%),对照组仅有4例(19.0%),差异有统计学意义(P=0.039)。③观察组骨折愈合时间较对照组长,末次随访时Harris评分低于对照组,差异有统计学意义(t=2.611,P=0.024;t=4.391,P=0.001)。结论:帕金森病患者股骨转子间骨折由于其复杂的病理特点,术后发生内固定失败、髋内翻畸形、肺部感染以及其他并发症的几率相对较高。对于该类骨折,选用髓内固定、术后早期活动、积极预防各种并发症、联合多学科制定综合康复计划等,对于取得良好的临床结果是很有必要的。更多还原

【Abstract】 Objective:To study the clinical features of the intertrochanteric fracture in patients with Parkinson disease and evaluate the curative effect of surgical treatment.Methods:From January 2003 to May 2008,we retrospectively analyzed 21 femoral intertrochanteric fractures in patients with Parkinson disease who had been treated surgically as experimental group.There were 17 females and 4 males,with the mean age of 73.6 years,ranged from 62 to 86 years.At the same period,each of 21 patients were matched with a case of the same sex,age(difference within 3 years),fracture classification,internal fixation method and combined disease but without Parkinson disease as control group.The information of operative time,intraoperative blood loss,ICU admission time,length of stay,complications were collected and compared between groups.The evaluation of pain and function status was done with Harris score.Results:The differences in operative time and intraoperative blood loss between two groups had no statistical significance(t=1.359,P=0.191;t=1.792,P=0.101),but the ICU admission time and length of stay were significantly longer in patients with Parkinson disease(t=30350,P=0.006;t=2.993,P=0.012).The overall complication rates were 57.1%(12/21)in Parkinson disease group,and 19.0%(4/21) in control group,there was statistical difference between the two groups(P=0.039).In addition,the fracture union time were longer and Harris score were lower in patients with Parkinson disease than those in control group(t=2.611,P=0.024;t=4.391,P=0.001).Conclusion:Because of the complex of clinical and pathological characteristics,the intertrochanteric fracture in patients with Parkinson disease has a high probability of implant failure,varus deformity of the hip,pulmonary infection,and other adverse clinical outcomes postoperatively.For these fracture,using intramedullary nail,postoperative early active mobilization,preventing various complications actively and a multidisciplinary rehabilitation program are necessary to obtain good clinical outcome.更多还原