老年同侧股骨粗隆间并股骨颈骨折的手术策略  

Operative strategy for elderly ipsilateral femoral neck and intertrochanteric fracture

作　　者：徐勇强[1] 阎戈[1] 康亦锋[1] 黄焱[1] 贾真[1] 陈润新[1] 廖新华[1] 冯嗣寅[1] 王愉思[1] 

机构地区：[1]湖南省人民医院创伤骨病科,湖南长沙410002

出　　处：《中国骨与关节损伤杂志》2016年第2期124-126,共3页Chinese Journal of Bone and Joint Injury

基　　金：湖南省科技厅计划项目(2013TT2012)

摘　　要：目的 探讨老年同侧股骨粗隆间并股骨颈骨折的手术治疗方法 。方法 回顾性分析自2010-02—2015-02诊治的24例老年同侧股骨粗隆间并股骨颈骨折的临床资料,其中18例采用股骨粗隆部重建、人工股骨头置换术,5例采用股骨近端锁定接骨板内固定,1例股骨粗隆间骨折Evans-JensenⅡ型患者采用LISS及空心钉内固定。结果 18例人工股骨头置换术后患者获得1年随访,均未见假体脱位、松动等并发症。6例采用股骨锁定接骨板的患者获得平均14.2（8~16）个月随访。术后1例出现股骨颈骨折不愈合,并出现股骨头变扁,髋关节间隙变窄等情况,予以拆除内固定物后,改行全髋关节置换术。其余5例应用内固定患者均达到骨折愈合,内固定物无松脱、断裂。结论 人工股骨头置换术和股骨锁定接骨板治疗老年同侧股骨粗隆间合并股骨颈骨折,疗效确切、满意,可根据患者年龄及骨折类型灵活应用上述手术方法 。Objective To explore the surgical method of the ipsilateral femoral neck and intertroehanteric fracture in elderly patients. Methods A retrospective analysis was eonducted on the clinical data of femoral troehanterie reconstruction combined with extended biological type artificial femoral head replacement and femoral locking plate fixation in the treatment of 24 elderly patients with ipsilateral femoral intertroehanteric and femoral neck fracture from February 2010 to February 2015. Results Eighteen patients with artificial femoral head replacement were followed up for 1 year, no prosthesis loosening or dislocation complications happened. Six femoral locking plate fixation patients were followed up for 8-16 months, with an average of 14.2 months. One case had fracture nonunion of femoral neck and avascular necrosis of the femoral head, the hip joint space narrowed. After removing internal fixation, this case was treated with total hip replacement. The other 5 cases treated by internal fixation reached clinical healing, without loosening or rupture of internal fixation. Conclusion The curative effeet of artificial femoral head replacement and proximal femur locking plate in treatment of ipsilateral femoral intertroehanterie and the femoral neck fracture in elderly patients is satisfactory. We should apply these two methods according to the patient＇s condition.

关 键 词：股骨颈骨折 股骨粗隆间骨折 人工股骨头置换术 内固定 老年人 

分 类 号：R687.3[医药卫生—骨科学]