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1、老年股骨粗隆間骨折手術(shù)治療【摘要】目的探討老年股骨粗隆間骨折的治療方法及效果。方法2000年1月至2005年1月，治療160例老年股骨粗隆間骨折患者，平均年齡78歲，95%合并內(nèi)科疾病。其中保守治療8例，切開復(fù)位內(nèi)固定術(shù)116例（DHS治療60例，PFN治療56例），人工關(guān)節(jié)置換36例。結(jié)果所有患者均獲得12?24個月的隨訪，保守治療及切開復(fù)位內(nèi)固定組骨折均愈合，無不愈合及死亡病例。人工關(guān)節(jié)組無術(shù)后早期脫位、人工假體下沉、斷裂、松動等并發(fā)癥發(fā)生。所有患者日常生活能自理，無嚴重疼痛、功能障礙，療效滿意。按Harris評分標(biāo)準(zhǔn)，優(yōu)良率保守治療組為70%,DHS組90%,PFN組87
2、.5%,人工關(guān)節(jié)組92.3%。結(jié)論對老年股骨粗隆間骨折，應(yīng)積極進行手術(shù)治療，充分術(shù)前準(zhǔn)備，根據(jù)患者的健康狀況及骨折類型選擇適合不同患者的治療方法，減少骨折并發(fā)癥的發(fā)生，提高老年人的生活質(zhì)量?！娟P(guān)鍵詞】股骨粗隆間骨折股骨近端髓內(nèi)釘動力體螺釘內(nèi)固定術(shù)人工關(guān)節(jié)置換術(shù)OperativeTreatmentofOldagePatientswithIntertrochantericFractureAbstract:ObjectiveTodiscussthemethodandclinicalresuItsofoldagepatientswithintertrochantericfracture
3、s.MethodsFromJanuary2000toJanuary2005,160caseswithintertrochantericfracturesweretreatedinourdepartment.Theaverageageofthepatientswas78yearsold,95%ofthemsufferedfromcomplicatedmedicaldisease.8ofthemweretreatedwithconservativetraction,116ofthemweretreatedwithinternalfixation(60withdynamichipsc
4、rews,56withproximalfemoralnail),and36ofthemweretreatedwithartificialjoint.ResultsAllthepatientswerefollowedupfor12to24months.Allthefractureshealedandnoonediedinconservativeandinternalfixationgroup.Therewasnoearlierperioddislocation,sinkingorsofteningandbreakingofprosthesisinartificaljointgro
5、up.Allofthepatientscouldtakecareofdailylifebythemselvesandweresatisfiedwiththeoutcome.Noseriouspainordysfunctionwerefoundinthepatients.AccordingtoHarrisscoresystem,theexcellentandgoodrateis70%inconservativegroup,90%inDHSgroup,87.5%inDHSgroup,and92.3%inartificialjointgrouprespectively.Conclus
6、ionOperativetreatmentshouldbeperformedinoldagepatientswithintertrochantericfracturesactively.Thepreoperativepreparationshouldbedonesufficiently.Propermethodshouldbedeterminedonthebasisofphysicalconditionsandfracturetypesofthedifferentpatients.Thefinaltherapeuticobjectiveistodecreasecomplicat
7、ionsoffractureandimprovethequalityoflifeoftheoldpeople?Keywords:intertrochantericfracture；proximalfemoralnail；dynamichipscrews；internalfixation；artificialjointreplacement老年股骨粗隆間骨折患者常伴有骨質(zhì)疏松癥，且并存各種疾病，使用保守療法，2?3個月的臥床牽引雖然在部分病例中能達到愈合目的，但易引起心肺功能下降、褥瘡和墜積性
