Ding Tao, Zhang Baokun, Tian Shaoqi, Wang Yuanhe, Sun Kang
Department of Articular Surgery, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266555, P.R.China.
Department of Trauma Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, 200233, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 Nov 15;32(11):1435-1440. doi: 10.7507/1002-1892.201804084.
To summarize the selection criteria and clinical application of surgical methods for hip fractures (femoral neck fracture and intertrochanteric fracture) in the elderly.
The related literature concerning the surgical methods for femoral neck fracture and intertrochanteric fracture in the elderly at home and abroad was extensively reviewed and summarized.
Among the elderly patients with femoral neck fracture, the closed reduction and internal fixation or dynamic hip screw (DHS), and total hip arthroplasty are recommended for patients under 65 years old and 65-80 years old respectively and without special surgical contraindication; whereas hemiarthroplasty is recommended for patients with poor physical conditions. Among the patients with intertrochanteric fracture, DHS or the 3rd generation of Gamma nails is recommended for patients with stable fracture while the intramedullary fixation systems (e.g., proximal femoral nail anti-rotation, intertrochanteric antegrade nail) and the extramedullary fixation systems (e.g., proximal femoral locking compression plate and less invasive stabilization system) can be applied to the patients with unstable fracture according to the fracture type and bone conditions. Notably, hip arthroplasty is recommended for elderly patients with comminuted fracture.
The surgical method and internal fixator should be chosen according to the fracture type and bone condition in the elderly in order to improve the effectiveness and reduce the complication.
总结老年人髋部骨折（股骨颈骨折和转子间骨折）手术方法的选择标准及临床应用。
广泛查阅并总结国内外有关老年人股骨颈骨折和转子间骨折手术方法的相关文献。
在老年股骨颈骨折患者中，对于65岁以下且无特殊手术禁忌证的患者，建议行闭合复位内固定或动力髋螺钉（DHS）固定；对于65 - 80岁且无特殊手术禁忌证的患者，建议行全髋关节置换术；而身体状况较差的患者建议行半髋关节置换术。在转子间骨折患者中，对于骨折稳定的患者，建议采用DHS或第三代Gamma钉固定；对于骨折不稳定的患者，可根据骨折类型和骨质情况应用髓内固定系统（如股骨近端抗旋髓内钉、转子间顺行髓内钉）和髓外固定系统（如股骨近端锁定加压钢板、微创稳定系统）。值得注意的是，对于粉碎性骨折的老年患者，建议行髋关节置换术。
老年人应根据骨折类型和骨质情况选择手术方法及内固定物，以提高疗效并减少并发症。
