老年患者股骨粗隆间骨折手术及围术期治疗分析

摘要

Objective To analysis of elderly patients with femoral intertrochanteric fracture treatment methods and perioperation period complication prevention and treatment.Methods From June 2004 to December 2011,in our department 58 cases of femoral intertrochanteric fracture patients adopted open reduction and proximal femoral locking plate internal fixation.According to the Ev-ans type which Jensen modified,type I in 8 cases,Ⅱ 14 cases,Ⅲ 16 cases,Ⅳ 13 cases,Ⅴ7 cases.40 patients complicated by internal diseases,accounted for 68.97%.Among them,25 patients with single medical disease(9 cases of circulatory diseases,6 cases of disease of respiratory system,urinary system disease in 5 cases,3 case of disease of digestive system,nervous system disease in 2 cases) ,15 cases with more than two diseases.Results 58 cases were followed up,follow-up time of 6 months to 5 years,average 32 months.During the hospital stay with no deaths,which occurred in 22 cases early and late complications,pulmonary infection in 6 cases,2 cases with deep vein thrombosis,mental abnormality in 5 cases,4 cases of coxa vara,5 cases of internal fixation failure,2 cases of death due to other causes in six months after operation.According to the Harris hip function score,the group had excellent in 44 cases,better in 3 cases,good in 6 cases and poor in 5 cases.Conclusion Operation therapy of senile femoral intertrochanteric fracture patients complicated by internal diseases has risk,so surgeons should take active and effective treatment to control medical diseases before surgery,and reduce trauma,shorten the operation time.Then take operation therapy we can get good effects.%目的 分析老年患者股骨粗隆间骨折的治疗方法 和围术期的并发症预防与治疗.方法 选取2004年6月至2011年12月将有手术指征的58例股骨粗隆间粉碎性骨折患者采取切开复位股骨近端锁定钢板内固定术.按照Jensen改良的Evans分型,Ⅰ型8例,Ⅱ型14例,Ⅲ型16例,Ⅳ型13例,Ⅴ型7例.合并内科基础疾病40例,占68.97%,其中25例合并1种内科疾病(循环系统疾病9例,呼吸系统疾病6例,泌尿系统疾病5例,消化系统疾病3例,神经系统疾病2例),15例并存2种或2种以上内科基础疾病.结果 本组58例均获得随访,随访时间6个月至5年,平均32个月.住院期间无1例死亡,其中22例出现近远期并发症,肺部感染6例,深静脉血栓2例,精神异常5例,髋内翻4例,内固定意外5例.术后6个月内因多器官功能衰竭死亡2例.按Harris髋关节功能评分标准:优44例,较好3例,良6例,差5例.结论 老年股骨粗隆间粉碎性骨折患者合并内科基础疾病的手术治疗存在风险性,医生术前应对内科基础疾病采取积极有效治疗,术中减轻创伤,缩短手术时间,采取手术治疗可取得较好的疗效.