分阶段治疗老年股骨粗隆间骨折的临床观察.docVIP

分阶段治疗老年股骨粗隆间骨折的临床观察 郭飞1 张元平1刘兴炎2单敏1李双平1宋军峰1吕宏学1邵炯光1杨胜奇1闫华1邓永盛1 1兰州军区临潼疗养院附属医院创伤骨科, 陕西西安710600 2兰州军区总医院全军骨科中心，甘肃兰州 730000 摘要: 目的　研究老年股骨粗隆间骨折分阶段治疗的效果，为老年股骨粗隆间骨折探索一种安全而有效的治疗方法。方法 将2002年5月至2008年6月在我院住院治疗的老年股骨粗隆间骨折病人132例，随机分为二组，实验组：伤后三周手术（62例）;对照组：伤后一周手术（70例）。所有患者术前先行患肢骨牵引，进行内科疾病的治疗，分别按组于一周时、三周时行骨折锁定钢板内固定手术，将二组患者术中平均出血量、手术历时、术后早期并发症情况、术后患肢短缩率、颈干角丢失率相比较，并进行统计学分析。结果　实验组患者平均术中出血量231.38±64.73 ml,对照组为442.64±32.66 ml，P＜0.01。实验组平均手术时间为115.46±42.52 min,对照组为158.52±60.18 min，P＜0.05。实验组术后早期并发症共9例（14.51%），对照组20例（28.57%）, P＜0.05。实验组术后出现患肢短缩5例（8.06%）,对照组11例（15.71%）, P＜0.05。实验组术后出现颈干角丢失6例（9.67%）,对照组术后出现颈干角丢失15例（21.42%）, P＜0.01。结论　对于老年股骨粗隆间骨折宜分阶段治疗,先行骨牵引三周使骨折复位，同时有充分时间进行内科合并症治疗，待骨折解剖复位并且骨折间已形成纤维连接时再行锁定钢板内固定治疗，不仅伤口暴露小，减少创伤，而且手术历时短，出血少，从而降低了患者的手术风险，术后早期并发症少，骨折愈合后肢体短缩及颈干角丢失的机率大为减少。 关键词 股骨转子间骨折；手术时机；锁定钢板；并发症；治疗 Aged intertrochanteric fracture of the femur treated with anatomic plate at different operation opportunity ZHANG Yuanping, GUO Fei ,CUI Jixiu. 1 Department of Orthopaedics of affiliated hospital, Lintong Sanatorium, Lanzhou military area, Xian 710600, China 21st convalescent department of Lintong Sanatorium, Lanzhou Military Command, Xian 710600, China 【Abstract】 Objective To study the cure effects of aged intertrochanteric fracture of the femur treated by stage and explore a safety and effective method . Method 132 cases from May, 2002 to June,2008 aged intertrochanteric fracture of the femur were randomly divided into two groups. Trial group with 62 cases were operated at the 3th week after injory; Control group with 70 cases at the 1st week after injory. All patients were cured by bone traction, as well as their physical diseases were treated preoperatively. Then, they were fixed with locking compression plate at the time acording to group designed. The mean blood loss, mean operative time, rates of early postoperative complication, crispation and neck shaft angels loss were analyzed by statistics software. Results The mean blood loss in trial group was 231.38±64.