骨折类型与老年髋部骨折术后疗效分析  

Influnence of hip fracture type on outcome in elderly hip fracture

作　　者：戴兵[1] 骆洪涛[1] 孟祥德[1] 张浩[1] 司庆华[1] 崔世光[1] 

机构地区：[1]空军航空医学研究所附属医院骨科,北京100089

出　　处：《中华临床医师杂志（电子版）》2010年第5期630-634,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨老年髋部骨折类型对术后疗效的影响。方法 2007年4月至2008年11月收治老年髋部骨折患者121例。入组后根据X线表现将髋部骨折分为非移位型股骨颈骨折、移位型股骨颈骨折、稳定型股骨转子间骨折和非稳定型股骨转子间骨折四种。详细记录患者并存症、手术细节、术后并发症等。观察四组患者住院期间、术后6个月、12个月四种骨折患者的死亡率以及功能恢复情况。结果符合入选标准93例,其中不稳定型股骨转子间骨折22例,稳定型股骨转子间骨折30例,移位型股骨颈骨折19例,非移位型股骨颈骨折22例。四组患者年龄、并存症等一般情况差异无统计学意义。住院期间、术后6个月移位型股骨颈骨折患者死亡率较其他三组高,但差异无统计学意义;而术后12个月不稳定型股骨转子间骨折患者死亡率较其他三组明显升高。此外出院时移位型股骨颈骨折患者ADL评分较其他三组明显升高;术后6个月、12个月四组患者ADL评分差异无统计学意义。结论排除自身差异后,髋部骨折类型对术后疗效具有一定影响。早期(住院期间、术后6个月)移位型股骨颈骨折死亡率较其他三种类型骨折高,晚期(术后12个月)不稳定型股骨转子间骨折死亡率较其他三种类型髋部骨折高。骨折类型对术后功能恢复影响主要表现在短期效果上,移位型股骨颈骨折术后出院时ADL评分较其他三组好,但从长期效果来看,四组髋部骨折功能状况是相同的。Objective To study the influnence of fracture type on outcome in elderly hip fracture. Methods 121 patients with hip fracture were treated from April 2007 to November 2008. Orthopaedists radiographically classify the fractures as either:( 1) unstable intertrochanteric fracture; ( 2) stable intertrochanteric; ( 3) displaced femoral neck; ( 4) non-displaced or impacted femoral neck. Comorbidities,operative details,and postoperative complications were recorded. We observe the the mortality and functional outcome at discharge,6 month postoperatively,12 month after operation. Results 93 cases meet the inclusion criteria,of which 22 cases were unstable intertrochanteric fracture,30 cases in stable intertrochanteric,19 cases of displaced femoral neck,and 22 cases in non-displaced or impacted femoral neck. Age,comorbidities for patients own situation show no significant between 4 group. Although the mortality in displaced femoral neck patients are higher than others at discharge,6 months postoperatively,they do not reach statistically significant difference; the mortality in unstable intertrochanteric fracture show significant increase than others. In addition the ADL score in displaced femoral neck show significant increase than others at discharge; there are no significant differences of ADL scores between these 4 groups at 6th month,12th month postoperatively. Conclusions Hip fracture type have some influence on outcome when rolling out patients status differences. Displaced femoral neck fractures have higher mortality in the early ( hospitalized,6 months after operation) ,but patients in unstable intertrochanteric fracture show significant increase of mortality later( 12 months postoperatively). The influmence of hip fracture type on function recover mainly reflect in short-term. The ADL scores in displaced femoral neck fractures are higher than others at discharge,and little differences between the four groups in the long run were found.

关 键 词：髋骨折 老年人 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]