【摘要】 目的:分析不同方法治疗高龄股骨粗隆骨折的临床疗效。方法:采用牵引或闭合复位内固定治疗254例高龄股骨粗隆骨折,男105例,女149例;年龄70~94岁,平均77岁。其中牵引治疗(A组)53例,闭合复位DHS内固定治疗(B组)136例,闭合复位Gamm a钉或PFN治疗(C组)65例。参照Parker髋关节功能标准评定各组的治疗效果。结果:254例均获得随访,平均随访时间36个月。A组骨折后30 d死亡率13.2%(7/53),1年死亡率47.2%(25/53),髋内翻畸形28.3%(15/53),平均骨折愈合时间(11.5±3.2)个月,功能评分(4.8±0.6)分。B组骨折后30 d死亡率8.8%(12/136),1年死亡率22.8%(31/136),髋内翻畸形7.4%(10/136),平均骨折愈合时间(12.1±2.3)个月,功能评分(6.8±0.3)分,手术切口感染2.9%(4/136)。C组骨折后30 d死亡率9.2%(6/65),1年死亡率29.2%(19/65),髋内翻畸形12.3%(8/65),平均骨折愈合时间(11.8±3.8)个月,功能评分(6.9±0.5)分,手术切口感染3.1%(2/65)。A、B、C组比较,A组骨折后30 d和1年死亡率均明显高(P<0.01),髋内翻畸形发生率明显高(P<0.01),功能评分明显低(P<0.05)。B组与C组比较,死亡率、感染率、髋内翻发生率、功能评分、手术时间、术中出血及平均骨折愈合时间均无显著性统计学意义(P>0.05)。结论:高龄患者股骨粗隆骨折,要尽量创造手术条件,及早手术治疗;手术的方法主要根据骨折的类型和医师的熟练程度而定,闭合复位DHS内固定或交锁髓内钉内固定是较好的方法。更多还原

【Abstract】 Objective:To explore the results of femoral intertrochanteric fracture in patients older than seventy by traction and various surgical techniques.Methods:Two hundred and fifty-four patients older than seventy were selected,all suffered from femoral intertrochanteric fracture.Traction was used for fifty-three patients(group A),close reduction and internal fixation was performed for the others.Among the patients who accepted internal fixation,one hundred and thirty-six were fixed by DHS(group B),sixty-five by interlocking nail,including Gamma nail and PFN(group C).The data of each group were collected for statistical analysis on the following aspects:mortality in 30 days and in one year,the rate of coxa varus,the time of bone healing,the restored function,operative time(B and C),blood loss(B and C),the rate of infection(B and C).Results:Two hundreds and fifty-four patients were followed-up for 36 months in average.In the group A,mortality was 13.2%(7/53) in 30 days and 47.2%(25/53)in one year.It was 8.8%(12/136)in 30 days and 22.8%(31/136)in one year in the group B,while 9.2 %(6/65)and 29.2%(19/65)respectively at the same period in the group C.The rate of coxa varus deformity was 28.3%(15/53)in group A,7.4%(10/136)in B and 12.3%(8/165)in C.The bone healing time was(11.5±3.2)months in group A,(12.1±2.3)in B and(11.8±3.8) in C.The restored function scores after treatment was(4.8±0.6)in group A,(6.8±0.3)in B and(6.9±0.5)in C.The mortality and the rate of coxa varus in the group A were significant higher than the other,while the scores of the restored function were significant lower.There were no significant differences between the group B and C(P>0.05).Conclusion:Femoral intertrochanteric fracture in patients older than seventy should be treated by surgery rather than traction if the general condition is fairly good.Close reduction and fixed by either DHS or interlocking nail can get satisfactory results.更多还原