老年股骨转子间骨折合并帕金森病的治疗体会  

Surgical Treatment of Intertrochanteric Femoral Fracture in Patients with Parkinson＆#39;s Disease

作　　者：包先国[1] 孙天胜[1] 侯景明[1] 赵建文[1] 钟剑峰[1] 

机构地区：[1]北京军区总医院骨科,北京100700

出　　处：《医学临床研究》2015年第1期93-96,共4页Journal of Clinical Research

摘　　要：目的研究股骨转子间骨折合并帕金森病的患者的手术方法及围手术期处理。方法回顾性研究2005年3月至2012年5月收治的股骨转子间骨折合并帕金森的病例19例临床资料，其中男6例，女13例，平均年龄76．4（64～89）岁；Ⅱ型2例，Ⅲ型4例，Ⅳ型7例，Ⅴ型6例。动力髋螺钉（DHS）治疗6例，股骨近端防旋髓内钉（PFNA）治疗13例。对手术患者进行术前和术后 Harris评分。结果19例患者均安全度过围手术期，所有病例都获得随访，随访时间30．2（6～72）个月，手术切口均为一期愈合，无感染、神经损伤和再骨折并发症发生；Harris评分从术前的24～36（25．7±6．0）分恢复至末次随访时的65～86（78．5±4．9）分，DHS组1例遗留轻度跛行及髋内翻，主钉切割股骨头，行胫骨结节骨牵引3周并延迟下地至达到骨性愈合。PFNA组13例手术后随访固定效果较好，没有出现明显的后遗症。结论对于伴有帕金森病的股骨转子间骨折的患者，在围手术注意处理合并症及并发症，选择正确合适的手术方式和内固定种类，可以使患者早日获得痊愈。[Objective]To explore the surgical approaches and preoperative measures of intertrochanteric femoral fracture in patients with Parkinson＇s disease （PD） patients .[Methods]A retrospective study was per‐formed for 19 intertrochanteric fracture patients with PD .There were 6 males and 13 females with an average age of 76 .4 （64~89） years .According to the classification scheme of Evans‐Jensen ,the fracture types wereⅡ （ n=2） ,Ⅲ （ n =4） ,Ⅳ （ n=7） and V （ n=6） .The treatments were dynamic hip screw （DHS ,n=6） and proximal femoral nail antirotation （PFNA ,n=13） .And the preoperative and postoperative scores of Har‐ris were evaluated .[Results]All patients were safe during perioperative period .The mean follow‐up period was 30 .2 （6~72） months .Operative incision healed without infection ,nerve damage or fracture complica‐tions .The average Harris scores increased from preoperative （25 .7 ± 6） （24~36） to （78 .5 ± 4 .9） （65~86） points at the last follow‐up .In DHS group ,1 case had mild claudication ,coxa vara and nail cutting femoral . And tibial tubercle traction was applied for 3 weeks and there was delayed bone healing .Better fixation was a‐chieved for PFNA group and there was no obvious sequel .[Conclusion] For femoral fracture with Parkinson disease ,a surgeon should pay close attention to treating complications and selecting proper surgical and fixa‐tion approaches to achieve rapid healing .

关 键 词：股骨颈骨折/并发症 股骨颈骨折/外科学 帕金森病/并发症 手术期间 老年人 

分 类 号：R683.421[医药卫生—骨科学]