老年患者再发髋部骨折的综合治疗  

Treating strategy of second hip fractures in elderly patients

作　　者：邹雄飞[1] 张保中[1] 翁习生[1] 林进[1] 金今[1] 张万利[1] 钱文伟[1] 张嘉[1] 高鹏[1] 常晓[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院骨科,100730

出　　处：《北京医学》2017年第2期138-142,共5页Beijing Medical Journal

摘　　要：目的探讨老年再发髋部骨折的治疗策略。方法我科2005年1月至2014年12月收治老年再发髋部骨折患者56例,其中男15例,女41例;年龄71~96岁,平均82.1岁。初次骨折类型:股骨颈骨折46例,股骨转子间骨折10例;3例保守治愈,53例手术治愈。再发骨折部位:同侧1例,对侧55例;再发骨折类型:股骨颈骨折43例,股骨转子间骨折13例;均早期手术治疗,并强化抗骨质疏松治疗。结果术后1年内死亡3例,死亡率为5.4%,53例患者获得1年以上随访。股骨颈骨折术后假体位置均良好。股骨转子间骨折均获得骨性愈合,平均15.3周。按Harris髋关节功能评分标准:优23例,良20例,可10例,优良率为81.1%。结论对老年再发髋部骨折的患者,早期手术治疗仍是主要的治疗原则,大型综合医院多科协作的模式、较高的医疗水平有助于提高疗效、降低死亡率,同时应努力强化抗骨质疏松治疗等二级预防措施。Objective To discuss the treating strategy for second hip fractures in elderly patients. Methods From January 2005 to December 2014, 56 cases of second hip fractures were treated, 15 of which were male and the average age was 82.1 years （range 71-96）. Forty-six cases were femoral neck fractures and 10 were intertrochanteric fractures. Fifty-three of the 56 cases were treated with surgery and the other 3 with conservative treatment. Sites and type of second fractures was ipsilateral in 1 case and contralateral in 55. While 43 cases were femoral neck fractures and 13 were intertrochanteric fractures. All cases underwent operation and accepted enhanced anti-osteoporosis therapy. Results Fifty- three patients were followed up for 12 to 75 months （average 21.8 months） and all of which attained fracture healing （the average fracture healing time was 15.3 weeks） for intertrochanteric fractures and good positioning of prosthesis for femoral neck fractures. According to Harris hip performance score, 23 cases were excellent, 20 were good, and 10 were fair. The total excellent and good rate was 81.1%. Conclusion For elderly patients with second hip fractures, surgical treatment and enhanced anti-osteoporosis therapy are critical procedures. Multi-disciplinary cooperation in large medical centers may be helpful to reduce perioperative mortality.

关 键 词：老年 髋部骨折 再发 骨质疏松症 

分 类 号：R687.3[医药卫生—骨科学]