老年股骨转子间骨折手术方式选择的探讨(附180例报告)  

Operation Style Selection of Intertrochanteric Femoral Fractures in Elderly Patients(Report of 180 cases)

作　　者：陈佳[1] 李超英[1] 李建刚[1] 陈洪卫[1] 程宏彬[1] 

机构地区：[1]天津市第四中心医院,天津300140

出　　处：《哈尔滨医药》2010年第4期13-14,共2页Harbin Medical Journal

摘　　要：目的探讨我院骨科自2005年以来收治并得到随访的180例老年股骨转子间骨折手术方式的选择。方法 180例老年股骨转子间骨折患者根据美国麻醉师协会病情评估分级标准（ASA）进行术前评估,骨折按Evans分型,I型25例,Ⅱ型34例,Ⅲa型37例,Ⅲb型32例,Ⅳ型42例,Ⅴ型10例。加压空心钉16例,动力髋螺钉（DHS）69例,解剖型锁定钢板23例,髓内钉（Gamm a钉或PFN钉）组56例,骨水泥型人工股骨头置换16例。180例患者均进行随访并作出不同术式的疗效分析。结果本组180例平均住院20d,住院期间无一例死亡,随访时间6-48个月,平均16个月。患髋功能按Harris评分标准进行评价,加压空心钉组优良率81.3%,DHS组优良率91.3%,解剖型锁定钢板组优良率91.3%,髓内钉组优良率92.9%,假体置换组优良率87.5%。结论手术应根据患者的身体状况、患者骨折类型、内固定物的生物力学特点选择内固定方法 。Objective To investigate the operation style selection in 180 intertrochanteric femoral fractures in elderly patients.Methods All 180 intertrochanteric femoral fractures in elderly patients were evaluated according American society of anesthesiologists before operation.All patients were divided according Evans classification system：type Ⅰ 25 patients,typeⅡ 34,typeⅢa 37,typeⅢb 42,type Ⅳ 42,type Ⅴ 10.Dynamic cannulated screw group 16 patients,DHS（dynamic hip screw）group 69,An anatomy locking plate group 23,intramedullary naiI（Gamma nail or PFN nail）group 56,bone cemended prosthetic replacement group 10.ALL 180 patients were followed up and analyzed the curative effect of different operation style.Results The average time in hospital are 20 days,no expiration during hospital stay.All patients were followed up from 6 months to 48 months with 16 months on the average.Evaluate the ioint function of hip by Harris scoring system,Dynamic cannulated screw group excellent and good rates were 81.3%,DHS group excellent and good rates were 91.3%,An anatomy locking plate group excellent and good rates were 91.3%,intramedullary naiI group excellent and good rates were 92.9%,bone cemended prosthetic replacement group excellent and good rates were 87.5%.Conclusion The implant selection should consider patients physiclal status the classification of fracture and implant biomechanical feacher.

关 键 词：老年 股骨 转子间骨折 手术 

分 类 号：R615[医药卫生—外科学]