老年骨质疏松性髋部骨折的优化治疗方案

摘要

BACKGROUND:Active surgical treatments are preferred for elderly hip fractures. Individual fixation method is chosen according to fracture site, type, age and whether there are basic diseases in internal medicine, which plays an important role in the successful treatment of elderly hip fractures. OBJECTIVE:To explore the effects of optimized surgical treatment on osteoporotic hip fracture in the elderly. METHODS: Totally 176 patients with osteoporotic hip fracture were treated by different methods between January 2000 and January 2012, including 63 males and 113 females, with a mean age of (76.7±6.3) years. Out of the 84 cases of interchanteric fracture, seven cases were treated with conservative methods, 34 cases were treated with dynamic hip screw internal fixation, 18 cases were treated with cannulated screw internal fixation, seven cases were treated with anatomical plate internal fixation, 12 cases were treated with bipolar femoral placement, and six cases were treated with total hip arthroplasty. Out of the 92 cases with femoral neck fractures, 40 cases were treated with bipolar femoral placement, 37 cases were treated with total hip arthroplasty and 15 cases were treated with cannulated screw internal fixation. Modified Harris hip function scores were used to evaluate the therapeutic effects of different treatment methods. Complications were observed. RESULTS AND CONCLUSION:Seventy-six cases of interchanteric fractures and 85 cases of femoral neck fractures were fol owed-up for 8-26 months with an average of (5.7±1.3) months. Three cases suffered from post-operative infection, and one case died due to cardio-pulmonary failure in 10 days after operation. Both intraoperation and postoperative complications included femoral head cutting, intraoperative fracture, internal fixation and prosthetic loosening, postoperative fracture, avascular necrosis of femoral head, coxa vara, legs shorten, and delayed fracture healing. The incidence rates of complications in patients undergoing bipolar femoral placement and total hip arthroplasty were significantly lower than those treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P<0.05). The outcomes of the treatment according to Harris scoring criterion were better in patients treated with bipolar femoral placement and total hip arthroplasty than in patients treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P<0.05). No significant differences were found in the incidence rate of complications and Harris scores among patients treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P>0.05). No significant differences were found in the incidence rate of complications and Harris scores between patients treated with bipolar femoral placement and total hip arthroplasty (P>0.05). These findings indicate that the treatment of osteoporotic hip fracture in the elderly can achieve satisfactory results if the comprehensive therapies are given. Bipolar femoral placement and total hip arthroplasty are preferred for elderly femoral neck fractures.%背景：目前国内外学者对于老年性髋部骨折越来趋向于积极的手术治疗。手术治疗首先要根据不同骨折部位、骨折类型、不同年龄和是否合并有内科基础疾病从而选择不同的固定方式，对于老年性髋部骨折治疗的成败起到非常重要的作用。　　目的：探讨老年骨质疏松性髋部骨折的优化治疗方案。　　方法：2000年1月至2012年1月根据具体情况采用不同方法治疗老年骨质疏松性髋部骨折176例，年龄(76.7±6.3)岁。股骨转子间骨折84例，其中保守治疗7例，动力髋螺钉内固定34例，空心加压螺钉固定18例，解剖钢板内固定7例，人工股骨头置换12例，人工全髋关节置换6例。股骨颈骨折92例，其中双极人工股骨头置换40例，人工全髋关节置换37例，空心加压螺钉固定15例。不同治疗方法的治疗效果按 Harris 髋关节功能评分标准评定，并观察患者并发症发生情况。　　结果与结论：股骨转子间骨折76例，股骨颈骨折85例获随访，随访时间8-26个月。内固定治疗的平均愈合时间为(5.7±1.3)个月。3例发生治疗后感染，1例治疗后10 d 并发心肺功能衰竭死亡。不同治疗方法的并发症包括股骨头切割、围术期骨折，内固定或假体松动、术后骨折、股骨头缺血坏死、髋内翻、下肢短缩、骨折延期愈合及对髋再骨折等。双极人工股骨头置换与人工全髋关节置换患者的并发症发生率显著低于保守治疗、空心加压螺钉、解剖钢板及动力髋螺钉置入内固定患者(P<0.05)。双极人工股骨头置换与人工全髋关节置换患者的 Harris 评分优良率显著高于保守治疗、空心加压螺钉、解剖钢板及动力髋螺钉置入内固定患者(P<0.05)。而保守治疗、空心加压螺钉、解剖钢板及动力髋螺钉置入内固定患者相互之间的并发症发生率、Harris评分优良率比较，双极人工股骨头置换与人工全髋关节置换患者的并发症发生率、Harris评分优良率比较，差异无显著性意义(P>0.05)，提示老年骨质疏松性髋部骨折需要积极的综合治疗，对于高龄股骨颈骨折患者最好采用双极人工股骨头置换或人工全髋关节置换治疗为宜。