老年骨质疏松性股骨远端骨折的特点及治疗分析  

Clinical Features and Treatment Analysis of Distal Femur Fractures in Elderly Osteoporosis Patients

作　　者：杨恺[1] 曲宪芳[1] Yang Kai Qu Xianfang(Department of Orthopaedics,Affiliated Daxing Hospital of Capital Medical University,Beijing 102600,China)

机构地区：[1]首都医科大学大兴医院骨科,北京102600

出　　处：《实用骨科杂志》2016年第12期1065-1068,共4页Journal of Practical Orthopaedics

摘　　要：目的 探讨老年骨质疏松性股骨远端骨折的复杂临床特点及治疗策略。方法 回顾分析2010年3月至2014年2月收治的老年骨质疏松性股骨远端骨折15例,其中男性6例,女性9例,年龄65~77岁,平均69.6岁;AO分型C2型10例,C3型5例。所有患者采用前正中切口双锁定板法结合Ⅰ期髂骨植骨手术治疗,术后积极给予抗骨质疏松治疗及指导功能锻炼。定期随访和复查X线片,终末随访时进行膝关节功能评定。结果 老年骨质疏松患者的股骨远端骨折部位骨皮质明显变薄,骨松质孔隙率增大,骨折移位、严重粉碎,多伴有骨质缺损,且骨质缺损与术前影像学评估结果相比更为严重。术后经过12~18个月（平均13.7个月）随访,骨折完全愈合,愈合时间12~28周,平均18.3周。膝关节功能评定结果：优6例,良8例,差1例,优良率93.3%。结论 老年骨质疏松性股骨远端骨折伤情复杂,Ⅰ期髂骨植骨前正中切口双锁定板法是有效方法之一,具有显露清晰、可提供早期稳定和支撑、并发症少等优点。Objective To investigate the clinical features and treatment of distal femur fractures in elderly osteopo-rosis patients.Methods A retrospective analysis was made for 1 5 cases of distal femur fractures in elderly osteoporosis from March 2010 to February 2014,comprising of 6 male and 9 female with an average age of 69.6 years （ranged 65 to 77 years）.According to AO classification,10 cases were of type C2 and 5 of type C3.All patients were treated by stageⅠof bone graft procedures combined double-lock plating fixation via anteriormiddle approach.After operation,they were intervened by anti-osteoporosis treatment and functional exercise and guidance.All cases were followed up regular-ly and performed X-rays.The function of affected knee was evaluated at the end of the follow-up.Results The distal fe-mur fractures in elderly osteoporosis patients was displacement and comminuted.The bone cortex of distal femur was visible thin while the cancellous bone was sparse.And there was serious bone defect which was more severe than that of preoperative imaging evaluation.With follow-up time of 1 2~1 8 months （average 1 3 .7 months ）,all patients got bone-healing during 12 weeks to 28 weeks （average 18.3 weeks ）.According to knee functional evaluation,6 cases were excel-lent,8 good and 1 fair.The total excellent and good rate was 93.3%.Conclusion The distal femur fractures in elderly osteoporosis patients were much more complex.The surgery of stageⅠof bone graft procedures combined double-lock plating fixation via anteriormiddle approach is an effective way for them,which has advantages of obvious exposure, early stable fixation and support and less complication.

关 键 词：骨质疏松 股骨远端骨折 植骨 骨折固定术 

分 类 号：R683.42[医药卫生—骨科学]