Kang Wei-Jie, Xia Chen-Bo, Deng Yong-Jun, Zhang Ju-Shi
Department of Orthopaedics, Affiliated Hospital of Shaoxing College, Shaoxing 312000, Zhejiang, China.
Zhongguo Gu Shang. 2012 Jan;25(1):35-8.
To investigate the therapic choice of intertrochanteric fractures of femur in aged patient.
From June 2006 to June 2010,58 patients with intertrochanteric fracture were treated with surgical methods. There were 25 males and 33 females, aged from 65 to 93 years old (averaged 79 years old). According to the Evans type, type I was in 30 cases, type II was in 28 cases. Of them, 25 patients were treated with hip replacement (group A) and 33 patients were treated with internal fixation (group B). The operative time, blood loss volume, the time of get out of bed, drainage volume, complications and function of joint motion were compared between two groups. According to Harris scoring to evaluate function of joint motion at the 3rd, 6th, 12th months after operation.
All patients were followed up more than 12 months (averaged 16.4 months). One patient in group A died of pneumonia one month later after operation and other patients live safely through peri-operation. The group B was better than that of group A at operative time, blood loss volume, drainage volume. In group A, 1 case died and 1 case got DVT, 2 cases got urinary tract infection and 1 case got pneumonia. While in group B, 1 case got bedsore, 1 case got coxa vara and 2 cases got urinary tract infection. The incidence rate of complication in group B was lower than that of group A (P < 0.05). According to Harris scoring system, at the 3rd, 6th,12th months after operation, Harris scoring in group A was respectively (78.43 +/- 5.32), (81.67 +/- 4.87), (87.66 +/- 4.01) scores and in group B was respectively (75.45 +/- 3.22), (76.33 +/- 4.12), (88.65 +/- 3.77) scores. There was statistical significance in Harris scoring at the 3rd, 6th months after operation between two groups (P < 0.05) and there was no statistical significance at the 12th months after operation (P > 0.05). At three months after operation, in group A,14 cases obtained excellent results, 5 good, 5 fair and 1 poor; and in group B, 8 cases obtained excellent results, 13 good, 9 fair and 3 poor. Six months later, in group A,18 excellent, 5 good, 2 fair and 0 poor, and in group B,10 excellent, 15 good, 6 fair and 2 poor. Twelve months later,in group A,18 excellent, 5 good, 1 fair and 1 poor; and in group B, 21 excellent, 9 good, 3 fair and 0 poor. Three and six months later after operation, the clinical effect in group A was better than that of group B (P < 0.05); but twelve months later, there was no significant differences between two groups (P > 0.05).
The internal fixation is especially the preferred method for the aged patient with intertrochanteric fractures. Hip replacement refer to pathologicalfracture caused by cancer, unheeded fracture abnormity, osteoprosis too serious to be treated by internal fixation or patients with ipsilateral symptomatic degenerative joint or revisions caused by failed internal fixation and severely intertrochanteric comminuted fractures and merged severely osteoporosis.
探讨老年股骨粗隆间骨折的治疗选择。
2006年6月至2010年6月，58例股骨粗隆间骨折患者接受手术治疗。男性25例，女性33例，年龄65至93岁（平均79岁）。按Evans分型，Ⅰ型30例，Ⅱ型28例。其中25例患者行髋关节置换术（A组），33例患者行内固定术（B组）。比较两组手术时间、失血量、下床时间、引流量、并发症及关节活动功能。术后3个月、6个月、12个月按Harris评分评估关节活动功能。
所有患者均获随访12个月以上（平均16.4个月）。A组1例患者术后1个月死于肺炎，其余患者围手术期安全存活。B组手术时间、失血量、引流量优于A组。A组1例死亡，1例发生深静脉血栓，2例发生泌尿系统感染，1例发生肺炎。B组1例发生压疮，1例发生髋内翻，2例发生泌尿系统感染。B组并发症发生率低于A组（P<0.05）。按Harris评分系统，术后3个月、6个月、12个月，A组Harris评分分别为（78.43±5.32）分、（81.67±4.87）分、（87.66±4.01）分，B组分别为（75.45±3.22）分、（76.33±4.12）分、（88.65±3.77）分。术后3个月、6个月两组Harris评分差异有统计学意义（P<0.05），术后12个月差异无统计学意义（P>0.05）。术后3个月，A组优14例，良5例，可5例，差1例；B组优8例，良13例，可9例，差3例。6个月后，A组优18例、良5例、可2例、差0例，B组优10例,良15例,可6例,差2例。12个月后，A组优18例、良5例、可1例、差1例；B组优21例、良9例、可3例、差0例。术后3个月和6个月，A组临床效果优于B组（P<0.05）；但12个月后，两组差异无统计学意义（P>0.05）。
内固定术尤其适合老年股骨粗隆间骨折患者。髋关节置换适用于癌症所致病理性骨折、陈旧性骨折畸形、骨质疏松严重无法行内固定治疗或同侧有症状性退行性关节病患者，或内固定失败后翻修患者及严重股骨粗隆间粉碎性骨折合并严重骨质疏松患者。
