老年股骨粗隆間骨折的內固定治療及并發癥分析和手術危險性預測

老年股骨粗隆間骨折的內固定治療及并發癥分析和手術危險性預測

作者：曾劍文，謝文，朱錦宇，邊子虎，韓一生，朱慶生

【關鍵詞】 ,髖骨折
Complications and highrisk factors of internal fixation in elderly patients with intertrochanteric femoral fracture
　　【Abstract】 AIM: To compare the postoperative functional restoration and complication incidence of different therapies in elderly patients with intertrochanteric femoral fracture and to predict the highrisk factors of the operation. METHODS: One hundred and sixtyeight cases of elderly patients with intertrochanteric femoral fractures, who were treated from March, 1995 to June, 2001 were enrolled in the study. Of all the cases, 136 cases received internal fixation therapy and 83 cases were followed up for an average of 37.8 months. According to operative approach, types of fractures and age, the patients were divided into several groups and the therapeutic effects and complications were compared. By calculating composite exponent W of operation risks and mean ages of patients with complications (especially at early stage after operation), the prediction of the operation risk was made. RESULTS: Of the 83 cases, 67 (80.7%) had good functional restoration. Of the 10 (12.0%) cases with complications after operation, 3 cases suffered complications at early stage after operation. The duration and bleeding volume of operation in dynamic hip screw (DHS) internal fixation group were more than those in the other groups (P＜0.05). Hospitalization time in intramedullary pin internal fixation group was shorter than that in the other groups. Patients in the group of ages above 70 years had a bad functional restoration. Complication incidence between every two groups had no statistical significance. The average age in the 10 cases with complications was 82 years old. The mean age of 3 cases with early complications was 92 years old, whose exponent W was 6, 7 and 8 respectively. CONCLUSION: Suitable internal fixation materials should be chosen in the therapy of elderly patients with intertrochanteric femoral fractures. DHS, multipin, especially intramedullary pin, can satisfy the needs of fractures of various types for all ages. Age may be a high risk factor in the therapy of elderly patients with intertrochanteric femoral fracture.
　　【Keywords】 hip fractures; aged; internal fixation; postoperative complication; risk factors
　　【摘要】 目的： 比較不同內固定方法治療老年股骨粗隆間骨折的療效,并發癥發生原因并預測手術危險的高危因素. 方法： 199503/200106收治60歲以上老年股骨粗隆間骨折患者168例. 行手術內固定治療136例，83例獲得12~75（平均37.8） mo的隨訪，通過病歷分析獲得年齡、性別、骨折類型、手術方式、手術時間、住院天數、術中出血量、是否輸血以及輸血量、傷前生活自理能力、傷前身體狀況、術前血紅蛋白（Hb）水平、功能恢復及并發癥發生情況，分別按手術方式、骨折類型以及年齡分組比較其療效和并發癥發生情況，通過計算發生并發癥（尤其是術后早期并發癥）患者的平均年齡和手術危險性預測綜合指數W值，預測手術危險的高危因素. 結果： 本組83例，術后功能恢復優良67例，可9例，差7例；優良率80.7%. 術后發生并發癥10例，平均年齡為82歲，發生率12.0%，術后早期誘發原有合并癥3例,平均年齡為92歲. 動力髖內固定組的手術時間比其他兩組明顯延長（P＜0.05）；術中出血以及輸血量比其他兩組明顯增多；髓內釘內固定組住院天數比其他兩組明顯縮短；年齡大于70歲組功能恢復較差；以上比較均有統計學意義. 各組并發癥發生比較無顯著性差異. 早期誘發原有合并癥的3例患者，手術危險性預測綜

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