老年髋部骨折手术治疗的系统文献综述  

A systematic review of hip fractures in elderly people

作　　者：周武[1] 刘国辉[1] 杨述华[1] 邵增务[1] 米博斌[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,武汉430022

出　　处：《中华骨科杂志》2017年第17期1093-1099,共7页Chinese Journal of Orthopaedics

摘　　要：目的分析老年髋部骨折的好发年龄、发病部位以及不同治疗方式的效果和并发症。方法在数据库中检索“hip fractures，therapy，elderly”、“髋部骨折，治疗，老年”，时间选取1979年至2017年。所有被检索的文献均被用于分析，经文题、摘要及内容二次筛选，共筛选出32篇文献，将所涉及的髋部骨折患者作为研究对象，删除重复报告的病例；收集每例入选患者的发病年龄、性别、骨折部位、手术方式、随访时间、并发症等。采用系统分析的方法对数据进行分项研究。结果筛选出的32篇文献中，共2758例老年髋部骨折患者纳入系统研究，其中股骨颈骨折1791例，转子间骨折967例，股骨颈骨折：转子间骨折=1．85：1；发病年龄54-92岁，平均76．7岁，高发年龄70-79岁（52．4％，1445／2758）；男1037例，女1721例，男、女比例1：1．66；随访时间0．5-18年，平均7．8年。其中股骨颈骨折采用3枚空心拉力螺钉内固定治疗927例，术后并发骨折不愈合278例（29．9％），并发股骨头坏死139例（15．1％），并发内固定松动19例（2．0％）；采用动力髋（DHS）系统内固定治疗183例，并发骨折不愈合51例（28．1％），并发股骨头坏死31例（17．0％），并发内固定松动3例（1．8％），并发切割效应27例（15％）；采用半髋关节置换术治疗400例，术后并发关节脱位6例（1．5％），并发股骨干骨折14例（3．5％），并发深部感染8例（2．0％）；采用全髋关节置换术治疗281例，术后并发关节脱位14例（5．O％），并发股骨干骨折11例（4．0％），并发深部感染10例（3．5％）。转子间骨折采用股骨近端髓内钉（PFN或PFNA）固定治疗354例，术后并发转子部位骨折18例（5．0％），并发髋内翻28例（8．1％），并发骨折移位32例（9．0％）；采用Gamma钉治疗210例，术后并发转子部位骨折17例（7．9Objective To study the age peak of incidence, pathologic sites, therapeutic effect and complications of different treatment for hip fractures in the elderly. Methods ＂Hip fractures, therapy, elderly＂ were used as key words to search arti- cles both in English and Chinese from 1979 to 2017. The articles were filtrated by title, abstract and full text and 32 of them were left. All the patients were objects of this study, but the repeated cases were excluded. The patients＇ data such as age of onset, gender, fracture type, operation method, follow-up time, and complications were collected and analyzed by systematic analysis. Re- suits Data of 2 758 patients in 32 papers had been collected for analysis. There were 1791 femoral neck fractures and 967 intertrochanteric fractures, with a ratio of 1.85 ： 1. The patients＇ age of onset was ranging from 54 to 92 years old, with an average of 76.7 years old, and the age peak of incidence was from 70 to 79 years old. The sex ratio was 1 ： 1.66 （ 1 037 males： 1721 females）. All the patients had been followed up for 0.5 to 18 years, （average, 7.8 years）. Among 927 femoral neck fractures who were treated by 3 lag screws, there were 278 cases of non-union （29.9%）, 139 femoral head necrosis（15.1%） and 19 internal fixation loosening （2.0%）; but for 183 femoral neck fractures who were treated by dynamic hip screws （DHS）, there were 51 cases of non-union （28.1%）, 31 femoral head necrosis（17.0%）, 3 internal fixation losening（1.8%）, and 27 cutting effect （15%）. Then for 400 femoral neck fractures who were treated by hemiarthroplasty, there were 6 cases of dislocation（1.5%）, 14 shaft fracture （3.5%）, 8 deep infection （2.0%）; while for 281 femoral neck fractures who were treated by total hip arthroplasty, there were 14 cases of dislocation （5.0%）, 11 shaft fracture （4.0%）, and 10 deep infection （3.5%）. On the other hand, for 354 intertrochanteric fractures who were treated by proximal femoral nail or proximal fe

关 键 词：老年人 髋 骨折 综述 

分 类 号：R687.3[医药卫生—骨科学]