Dong Liming, Liao Wenbo
Department of Orthopaedics, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Jul;23(7):773-6.
To investigate the operative procedure and the therapeutic effects of unstable femoral intertrochanteric fracture in elderly patients with rebuild septum bronchiale in artificial femoral head replacement.
From October 2005 to October 2007, 113 elderly patients with unstable femoral intertrochanteric fracture were treated with artificial femoral head replacement with fixation of femoral greater trochanter and smaller trochanter in the help of bone cement in 58 cases (test group) and with gamma-type bone nail in 55 cases (control group). In test group, there were 21 males and 37 females with an average age of 75 years, including 10 cases of type IIIA, 16 cases of type IIIB and 32 cases of type IV according to Evans-Jenson standard. In control group, there were 17 males and 38 females with an average age of 72.5 years, including 13 cases of type IIIA, 14 cases of type IIIB and 28 cases of type IV according to Evans-Jenson standard. All fractures were caused by fall damage. The disease course was 3 hours to 7.5 days (mean 1.4 days). The patients of two group complicated with osteoporosis, and complicated by one or several complications of coronary heart disease, hypertension, diabetes and chronic bronchitis. And all patients did not had fracture at other sites. There was no significant difference in general data between two groups (P > 0.05).
The operations were successful, the incision healed by first intention. There were significant differences in operation time, operative blood loss and blood-transfusion between two groups (P < 0.05). The two group were followed 12-36 months. There were significant differences (P < 0.05) in the incidence rate of complication and the excellent and good rate of hip function (by Harris standard) between the test group (3.4% and 93.1%) and the control group (16.4% and 70.9%) 12 months after operation.
The aged patients with intertrochanteric fracture can get good result through caput femoris replacement, and rebuild septum bronchiale is of great significance.
探讨人工股骨头置换中重建支气管隔治疗老年不稳定型股骨粗隆间骨折的手术方法及疗效。
2005年10月至2007年10月，113例老年不稳定型股骨粗隆间骨折患者，58例采用人工股骨头置换并在骨水泥辅助下固定股骨大转子和小转子（试验组），55例采用γ型骨钉固定（对照组）。试验组男21例，女37例，平均年龄75岁，按Evans-Jenson标准，ⅢA型10例，ⅢB型16例，Ⅳ型32例。对照组男17例，女38例，平均年龄72.5岁，按Evans-Jenson标准，ⅢA型13例，ⅢB型14例，Ⅳ型28例。所有骨折均由跌倒损伤所致。病程3小时至7.5天（平均1.4天）。两组患者均合并骨质疏松，并合并冠心病、高血压、糖尿病、慢性支气管炎中的一种或几种并发症。且所有患者其他部位均无骨折。两组一般资料比较差异无统计学意义（P＞0.05）。
手术均成功，切口一期愈合。两组手术时间、术中出血量及输血量比较差异有统计学意义（P＜0.05）。两组随访12～36个月。术后12个月试验组（并发症发生率3.4%，髋关节功能优良率93.1%）与对照组（并发症发生率16.4%，髋关节功能优良率70.9%）并发症发生率及髋关节功能优良率比较差异有统计学意义（P＜0.05）。
老年股骨粗隆间骨折患者行股骨头置换可取得良好效果，重建支气管隔具有重要意义。
