新鲜老年股骨颈骨折治疗方法的选择  

Surgical option in management of femoral neck fracture in elders

作　　者：叶伟胜[1] 张建国[1] 林枫松[1] 周连兴[1] 马宝通[1] 张铁良[1] 

机构地区：[1]天津市天津医院创伤骨科,天津300211

出　　处：《天津医科大学学报》2009年第2期298-301,共4页Journal of Tianjin Medical University

摘　　要：目的:探讨新鲜老年股骨颈骨折不同治疗方法的选择。方法:股骨颈骨折60岁以上(60～83)124例,男性55例,女性69例,平均年龄68.4岁。对无移位型或移位骨折易于复位者74例采用空心钉治疗,对移位骨折并有粉碎块,或有内科合并症者采用全髋27例或双动头半髋置换23例。术后常规给予活性D3、钙、降钙素或二磷酸盐药物。结果:随访2～4年,平均2.6年。空心钉组2例不愈合,9例出现股骨头坏死,其中移位骨折7例,但股骨颈骨折均愈合。另2例术后2周时出现感染,总并发症13例(17.6%),余功能优良可61例(82.4%)。全髋或半髋关节置换术组50例,1例术后2周出现脱位,1例发生术中假体周围骨折,3例术后1年内死于心脑血管病,2例1年后出现假体松动,共7例(14.0%)。功能优良35例,可8例,占86.0%。结论:对于无移位型老年性股骨颈骨折首选早期闭合复位,经皮空心钉内固定,疗效满意。对移位型股骨颈骨折,复位困难可选用骨水泥型全人工关节或双动半髋置换方法。给予活性D3、钙、降钙素或二磷酸盐药物,预防再骨折,假体松动或假体周围骨折的发生。Objective： To explore the option of treatment approaches in fresh fracture of femoral neck in elders. Methods： There were 124 cases in fracture of femoral neck in old patients over 60 years old （60- 83）. Among them the male were 55 cases and the female were 69 cases. 74 patients with undisplaced or displacement with easy reduction fractures received internal fixation with cancellous screws. In 50 patients with displaced fractures or mostly with internal complications, 27 patients were treated by arthroplasty and 23 patients were treated by hemi-arthroplasty. After operation calcium, alpha-Vitamin D3, nasal spray salmon calcitonin or alendronate were administrated. Results： The follow-up for 2-4 years （2.6 years on average）, 2 cases were non-union, and 9 cases developed to ischemic necrosis of femoral head, in which 7 cases belong to the displacement fractures, another 2 cases appeared infection of the hip after two weeks of operation, total complication rate reached 17.6% （13 cases） in the cancellous screw group. According to the Thompson and Epstein method, the excellent and good rate accomplished to 82.4% （61 cases）in this group. In the arthroplasty group （50 cases）, one case had hip dislocation in the two weeks post-operation, 1 case suffered peri-prostheses fracture intra-operation, 3 cases died of cerebra-cardio-vascular disease within one year post surgery. The prostheses loosing presented in two cases after one year of surgery. The complication rate was 14% （7 cases）. The excellent,good and fear rate reached 86.0% （43 cases）. Conclusion： For the treatment of elderly fracture of femoral neck, close reduction and cancellous screw internal fixation is a good method for less displaced fracture,and arthroplasty or hemi-arthroplasty for displaced fractures of the femoral neck. Administrate the calcium, alpha-Vitamin D3, calcitonin or alendronate may prevente re-fractures or loosing of the prostheses.

关 键 词：骨折 股骨颈 空心钉 人工关节 活性D3 钙 降钙素 二磷酸盐 老年 

分 类 号：R683.42[医药卫生—骨科学]