单边外固定器在老年股骨转子间骨折治疗中的应用  

Treatment of intertrochanteric fracture of femur in the elderly with unilateral external fixator

作　　者：李振宙[1] 侯树勋[1] 李文峰[1] 吴克俭[1] 张伟佳[1] 吴闻文[1] 

机构地区：[1]解放军总医院三○四临床部骨科,北京市100037

出　　处：《中华创伤骨科杂志》2005年第2期101-104,108,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的回顾分析闭合复位、单边外固定器固定治疗老年股骨转子间骨折的疗效。方法1997年6月～2003年6月,用单边外固定器治疗老年股骨转子间骨折63例,年龄65～93岁,平均77.8岁,所有患者至少合并一种以上系统性内科疾病。骨折类型包括顺转子间线骨折(Evans分型):Ⅰ型1例,Ⅱ型7例,ⅢA型27例,ⅢB型6例,Ⅳ型18例;逆转子间线骨折4例。结果所有患者随访5～30个月,平均17个月。骨折全部愈合,愈合时间8～20周,平均12周。最后一次随访时患者髋关节功能情况(创伤性髋关节评分系统):优33例、良24例、差6例。术后有8例出现针道感染,经口服抗生素及局部换药等处理好转,无深部感染及骨髓炎发生,无骨折不愈合及髋内翻,无肢体短缩等畸形愈合。结论单边外固定器治疗老年股骨转子间骨折可获得满意的骨折愈合和髋关节功能,对伴有系统性内科疾病的高危股骨转子间骨折患者是有价值的替代治疗方法。Objective To retrospectively analyze the results of unilateral external fixators and closed reduction in treatment of intertrochanteric fractures of femur in the elderly. Methods From June 1997 to June 2003, 63 high risk patients with intertrochanteric fractures were treated with closed reduction and unilateral external fixators. Their average age was 77.8 years (ranging from 65 to 93 years). All the patients were complicated with at least one systematic disease. According to Evans classification of intertrochanteric fracture of femur, there were 1 type Ⅰ, 7 type Ⅱ, 27 type ⅢA, 6 type ⅢB, and 18 type Ⅳ. There were also 4 cases of reverse intertrochanteric fractures in this group. Results The mean follow up was 17 months (5 to 30m). Bone healing was achieved in all patients. The time of bone healing was 8 to 20 weeks (averaging 12w). The latest follow up showed that the functional outcomes were excellent in 33 cases, good in 24 and poor in 6 according to traumatic hip rating score. Only 8 cases experienced superficial pin site infection that was settled with oral antibiotics and pin site care. No deep infection, osteomyelitis, nonunion or malunion was found. Conclusion Closed reduction and external fixators can be considered as a valuable alternative treatment for high risk geriatric patients with intertrochanteric fractures of femur.

关 键 词：股骨 骨折 骨折固定术 外 

分 类 号：R687.3[医药卫生—骨科学]