Outcomes of Operation Treatment of Osteoporotic Hip Fracture in the Elder
-
摘要:
目的 探讨老年骨质疏松性髋部骨折的手术治疗效果。 方 法2000年1月~2010年12月采用手术治疗老年骨质疏松性髋部骨折117 例,男53 例,女64 例;年龄65~95 岁,平均75.7±10.3 岁;股骨粗隆间骨折51 例,男24 例,女27 例;年龄66~95 岁,平均76.7±9.3岁,按Evans分型,Ⅰ型4例,Ⅱ型11例,Ⅲ型32例,Ⅳ型4例。DHS内固定36例,空心加压螺钉固定5例,人工股骨头置换6 例,Gamma钉内固定4 例。股骨颈骨折66 例,男29 例,女37 例;年龄65~92 岁,平均75.6±10.2 岁,按分Garden 分型,Ⅰ型5例,Ⅱ型13例,Ⅲ型21例,Ⅳ型27例。双极人工股骨头置换24例,人工全髋关节置换27例,空心加压螺钉固定15例。 结果股骨粗隆间骨折44例获随访,随访时间8~26个月,平均15.7±3.3个月,DHS平均愈合时间为6.7±1.3个月,有3例发生股骨钉的切割。2例发生术后感染,术后10 d并发心肺功能衰竭死亡。股骨颈骨折58例随访,随访时间8~25个月,平均16.7±2.3个月;按Harris评分标准:优31例,良22例,中14例,差1例,优良率为91.38%(53/58)。 结论对于骨质疏松性髋部骨折,采用手术治疗可以取得较为令人满意的疗效。 Abstract:ObjectiveTo explore the outcomes of operation treatment for osteoporotic hip fracture in the elder. Methods 117 patients with osteoporotic hip fracture were treated with operation methods between January 2000 and December 2010, which involved 53 males and 64 females, and with mean age 75.7±10.3 years(ranged from 65 to 95 year). 51 cases were suffered from interchanteric fracture, involved 24 males and 27 females, and with mean age 76.7±9.3 years(ranged from 66 to 95 years). All fractures in the cases were divided according to Evans standard, Ⅰtype in 4 cases, Ⅱtype in11 cases, Ⅲtype 32 in cases, Ⅳ type in 4 cases. 36 cases were treated by DHS, 5 cases by hollow pull screw, 6 cases by artificial bipolar femoral head replacement and 5 cases by Gamma screw. 66 cases were suffered from femur neck fracture, which involved 29 males and 37 females, and with mean 775.6±10.2 years(ranged from 65 to 92 year). All fractures were divided according to Garden standard, Ⅰtype in 5 cases, Ⅱtype in 13, Ⅲtype in 21 cases, Ⅳ type in 27 cases. 24 cases were treated by artificial bipolar femoral head replacement. 27 cases were by total hip replacement. 15 cases were by hollow pull screw. Results44 cases with interchanteric fracture were followed-up for 8~26 months with an average of 15.7±3.3 months. The average fracture healing time was 4.6 months in the DHS cases. A few of complications happen in the DHS cases, screw cutting occurred in 3 cases. 2 cases suffered from infection dead due to cardio-pulmonary failure in 10 days after operation. 58 cases with femur neck fracture were followed-up for 8~25 months with an average of 16.7±2.3 months. According to Harris scoring system, the outcomes were excellent in 30 cases, good in 22, fair in 14, and poor in 1, and the excellent good rate was 91.38%(53/58). ConclusionOperation management can achieve an excellent result in osteoporotic hip fracture in the elder. -
Key words:
- osteoporosis /
- hip /
- fracture /
- surgical procedures
-
[1] 林健, 石英杰, 李士春. 老年骨质疏松致髋部骨折的综合治疗[J]. 基层医学论坛, 2007, 11(24): 1076. http://www.cnki.com.cn/Article/CJFDTOTAL-YXLT200724018.htm [2] 高雷, 吴东辉. 老年髋部骨质疏松骨折综合治疗的临床意义[J]. 吉林医学, 2009, 30(7): 579-80. http://www.cnki.com.cn/Article/CJFDTOTAL-JLYX200907001.htm [3] 程斌, 杨峰, 宋金辉, 等. 老年人骨质疏松性髋部骨折的治疗[J]. 中国骨与关节损伤杂志, 2007, 22(12): 1025-6. http://www.cnki.com.cn/Article/CJFDTOTAL-GGJS200712032.htm [4] 张寿, 陈文远, 邢势. 骨质疏松性髋部骨折的治疗方法选择与疗效分析[J]. 中国老年学杂志, 2009, 29(13): 1598-600. http://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ200913004.htm [5] 林健, 石英杰, 李士春. 老年骨质疏松致髋部骨折的综合治疗[J]. 基层医学论坛, 2007, 11(24): 1076. http://www.cnki.com.cn/Article/CJFDTOTAL-YXLT200724018.htm [6] 郑晓佐, 徐振华, 汪平, 等. 股骨粗隆间骨折三种内固定方式治疗的选择[J]. 现代生物医学进展, 2009, 9(2): 284-6. http://www.cnki.com.cn/Article/CJFDTOTAL-SWCX200902029.htm [7] 王鹏建, 张超, 阮狄克, 等. 股骨粗隆间骨折的外科治疗策略及疗效分析[J]. 中国骨与关节损伤杂志, 2008, 23(12): 969-71. http://www.cnki.com.cn/Article/CJFDTOTAL-GGJS200812002.htm [8] 刘作华, 孙忠武, 孙守勇. 对老龄人群髋部骨折手术内固定的选择及相关治疗[J]. 中国矫形外科杂志, 2008, 16(12): 955-7. http://www.cnki.com.cn/Article/CJFDTOTAL-ZJXS200812027.htm [9] 王大伟, 苏波, 滕居赞, 等. 高龄老年不稳定型股骨转子间骨折DHS固定与股骨头置换的临床评估[J]. 中国骨与关节损伤杂志, 2006, 21 (6): 444-6. http://www.cnki.com.cn/Article/CJFDTOTAL-GGJS200606011.htm [10] 曹成福, 纪斌, 谢林, 等. 长柄人工股骨头置换治疗老年骨质疏松粉碎性股骨粗隆间骨折的临床研究[J]. 骨与关节损伤杂志, 2004, 19 (2): 81-3. http://www.cnki.com.cn/Article/CJFDTOTAL-GGJS200402003.htm [11] 陈鹏, 刘文和, 颜林淋, 等. 老年人骨质疏松性髋部骨折100例治疗探讨[J]. 中国临床新医学, 2012, 5(5): 410-2. http://www.cnki.com.cn/Article/CJFDTOTAL-ZYLN201205013.htm [12] 高雷, 吴东辉. 老年髋部骨质疏松骨折综合治疗的临床意义[J]. 吉林医学, 2009, 30(7): 579-80. http://www.cnki.com.cn/Article/CJFDTOTAL-JLYX200907001.htm [13] Zuckerman JD, Skovron ML, Koval KJ, et al. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip[J]. J Bone Joint Surg Am, 1995, 77(10): 1551-6. doi: 10.2106/00004623-199510000-00010 [14] 夏军, 黄钢勇, 黄煌渊. 80岁及以上髋部骨折患者围手术期治疗的探讨[J]. 中华老年医学杂志, 2005, 24(5): 355-7. http://www.cnki.com.cn/Article/CJFDTOTAL-ZHLN20050500A.htm [15] 李勇, 张志平, 许永武. 髋部骨密度与老年骨质疏松性髋部骨折的相关性[J]. 江西医药, 2005, 40(9): 570-2. http://www.cnki.com.cn/Article/CJFDTOTAL-JXYY200509045.htm [16] Verbeek DO, Ponsen KJ, Goslings JC, et al. Effect of surgical delay on outcome in hip fracture patients: a retrospective multivariate analysis of 192 patients[J]. Int Orthop, 2008, 32(1): 13-8. doi: 10.1007/s00264-006-0290-9 [17] 程斌, 杨峰, 宋金辉, 等. 老年人骨质疏松性髋部骨折的治疗[J]. 中国骨与关节损伤杂志, 2007, 22(12): 1025-6. http://www.cnki.com.cn/Article/CJFDTOTAL-GGJS200712032.htm [18] 刘作华, 孙忠武, 孙守勇. 对老龄人群髋部骨折手术内固定的选择及相关治疗[J]. 中国矫形外科杂志, 2008, 16(12): 955-7. http://www.cnki.com.cn/Article/CJFDTOTAL-ZJXS200812027.htm [19] 张寿, 孔长庚, 陈文远, 等. 骨质疏松性髋部骨折: 不同金属植入物治疗的比较[J]. 中国组织工程研究与临床康复, 2010, 14(22): 4176-80. http://www.cnki.com.cn/Article/CJFDTOTAL-XDKF201022061.htm [20] Adams C1, Robinson CM, Court- Brown CM, et al. Prospective randomized controlled trial of an intramedulary nail versus dynamic serow and plate for intertrochanteric fracture of the femur [J]. J Orthop Trauma, 2001, 15: 394-400. doi: 10.1097/00005131-200108000-00003 [21] 王志生, 王慧丽, 王志强, 等. 股骨颈骨折后不同时期股骨头内细胞凋亡与Fas 相关死亡结构域蛋白的表达[J]. 郑州大学学报:医学版, 2009, 44(1): 106-8. http://www.cnki.com.cn/Article/CJFDTOTAL-HNYK200901035.htm [22] 崔金雷. 老年股骨转子间骨折不同手术方法的疗效比较[J]. 郑州大学学报: 医学版, 2011, 46(4): 624-5. [23] 邝炯祥, 张光明, 肖学军, 等. 股骨近端髓内钉治疗不稳定型股骨粗隆间骨折[J]. 南方医科大学学报, 2009, 29(6): 1675-6. [24] 王海洲, 谢杰伟, 许树柴, 等. 老年股骨颈骨折治疗效果评价[J]. 南方医科大学学报, 2008, 28(7): 1279-80. [25] Tidermark J, Ponzer S, Svensson O, et al.Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. A randomised, controlled trial[J]. J Bone Joint Surg Br, 2003, 85(3): 380-8. doi: 10.1302/0301-620X.85B3.13609
点击查看大图
计量
- 文章访问数: 2017
- HTML全文浏览量: 227
- PDF下载量: 2
- 被引次数: 0