老年人股骨颈骨折治疗原则与治疗方法的选择  

The treatment principles and methods for femoral neck fracture in aged patients

作　　者：黄公怡[1] 胡建华[1] 高新生 

机构地区：[1]卫生部北京医院骨科,100730 [2]卫生部北京医院骨科股骨颈骨折目的,探讨老年人股骨颈骨折的治疗原则与治疗方法的选择依据。,方法,回顾性分析老年人股骨颈囊内骨折248例的临床资料,其中头下型97例,头颈型83例,经颈型68例。GardenⅠ型6例,Ⅱ型40例,Ⅲ型73例,Ⅳ型129例。有201例(81.0%)存在一种以上的并存症。全身健康状况综合评定:良好,中等和差者分别占50.8%,29.8%和15.7% [3]有手术禁忌证者占3.6%。其骨密度(BMD)均明显降低。非手术疗法23例,内固定术83例,人工股骨头置换术43例,全髋置换99例。,结果,经平均5.8年随访,并发症发生率为7.3%,无手术死亡。248例中,227例(91.5%)恢复行走功能,达到伤前生活活动能力 [4]非手术治疗组中需手术者2例(8.6%),内固定组需再次手术者8例(9.6%),人工股骨头假体松动或中央脱位需再次手术者4例(9.3%)。,结论,老年人,100730

出　　处：《中华老年医学杂志》1999年第6期325-327,共3页Chinese Journal of Geriatrics

摘　　要：目的　探讨老年人股骨颈骨折的治疗原则与治疗方法的选择依据。　方法　回顾性分析老年人股骨颈囊内骨折２４８ 例的临床资料，其中头下型９７ 例，头颈型８３例，经颈型６８ 例。ＧａｒｄｅｎⅠ型６例，Ⅱ型４０ 例，Ⅲ型７３ 例，Ⅳ型１２９ 例。有２０１ 例（８１．０％ ）存在一种以上的并存症。全身健康状况综合评定：良好、中等和差者分别占５０．８％ 、２９．８％ 和１５．７％ ；有手术禁忌证者占３．６％ 。其骨密度（ＢＭＤ）均明显降低。非手术疗法２３例，内固定术８３例，人工股骨头置换术４３例，全髋置换９９例。　结果　经平均５．８年随访，并发症发生率为７．３％ ，无手术死亡。２４８例中，２２７ 例（９１．５％ ）恢复行走功能，达到伤前生活活动能力；非手术治疗组中需手术者２例（８．６％ ），内固定组需再次手术者８ 例（９．６％ ），人工股骨头假体松动或中央脱位需再次手术者４例（９．３％ ）。　结论　老年人股骨颈骨折治疗方法的选择取决于患者全身健康状况、年龄、骨折类型及程度、骨的质量等因素，外科治疗的同时不应该忽视全身性并存症的治疗、重要脏器功能的改善以及骨质疏松症的治疗。Objective To find out the treatment principles and methods for femoral neck fracture in aged patients. Methods Two hundred and forty eight cases of femoral neck intracapsular fracture were treated from September 1991 to March 1997. The average age was 65 3 years with male 112 cases and female 136 cases. The subcapital fracture, trans head and neck fracture and trans neck fracture were 97, 83 and 68 cases respectively. According to Garden classification for the displacement of the fracture , there were 6 cases of Garden Ⅰ, 40 cases of Garden Ⅱ, 73 cases of Garden Ⅲ and 129 cases of Garden Ⅳ. Ninety three cases(37 5%) had one accompanying disease, 65 cases(26 2%) had two, 43 cases (17 3%) had three and over. Evaluation of the preoperative health condition was classified as good(126 cases, 50 8%), moderate (74 cases, 29 8%), poor (39 cases,15 7%), and contraindicated for operative treatment (9 cases, 3 7%). Twenty three were treated conservatively. Two hundred and twenty five cases were operated on with 83 of internal fixation, 43 of femoral head replacement (THR) and 99 of total hip prosthesis. Results The follow up period ranged in average of 5 8 years. Short term complications were present in 4 cases with pneumonia, one with pressure sore, 5 with thrombosis of lower extremity vein, 3 with dementia and 5 with cardiovascular diseases. In comparison with the control group, bone density of the hip area was lower. Revision operation included 8 cases of internal fixation and 4 cases of loosening of prosthesis. Two non operative cases had to be operated. Conclusions The aim of treating fracture of femoral head in elderly people is to decrease the rate of complication and mobility and improve the life quality. Selection of treating methods depends on health condition, age, type of fracture, level of displacement and bone density. Treatment alternative contains operation or non operation, internal fixation or joint replacement, femoral head replacement or THR, cement THR

关 键 词：股骨颈骨折 老年人 治疗 

分 类 号：R683.420.5[医药卫生—骨科学]