解剖钢板内固定治疗老年股骨转子间骨折不同手术时机的研究.docVIP

解剖钢板内固定治疗老年股骨转子间骨折不同手术时机的研究 张元平1 郭飞1 崔继秀2 摘要: 目的　研究老年股骨转子间骨折在不同手术时机应用解剖钢板内固定的治疗效果，确定老年股骨转子间骨折合适的手术时机及其对于提高手术安全性和治疗效果的意义。方法 将2005年8月至2007年10月在我院住院治疗的老年股骨转子间骨折病人98例，随机分为二组，实验组：伤后三周手术（52例）;对照组：伤后一周手术（46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、三周时行骨折解剖钢板内固定手术，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239.34±68.7 ml,对照组为439.34±82.4 ml，P＜0.01。实验组平均手术时间为117.68±54.2 min,对照组为153.27±62.31 min，P＜0.05。实验组术后早期并发症共7例（13.46%），对照组15例（32.61%）, P＜0.05。实验组术后出现患肢短缩4例（7.69%）,对照组9例（19.57%）, P＜0.05。实验组术后出现颈干角丢失5例（9.62%）,对照组术后出现颈干角丢失11例（23.91%）, P＜0.01。结论　对于老年股骨转子间骨折最佳手术时机是伤后三周，宜先行骨牵引复位，同时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解剖钢板内固定治疗，不仅伤口暴露小，减少损伤，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也大为减少。 关键词 股骨转子间骨折；手术时机；角度钢板；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 with anatomic plate at different operation opportunity. Method 98 cases from August, 2005 to October,2007 aged intertrochanteric fracture of the femur were randomly divided into two groups. Trial group with 52 cases were operated at the 3th week after injory; Control group with 46 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 anatomic 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 239.34±68.7 ml, 439.34±82.4 ml in control group(P＜0.0The operative tim