空心钉内固定治疗老年股骨颈骨折疗效观察.docVIP

空心钉内固定治疗老年股骨颈骨折疗效观察 作者：叶小雨，林初勇，张长松，沈新升 【摘要】 目的 评价老年股骨颈骨折空心钉内固定预后的影响因素，内固定治疗老年股骨颈骨折的可行性。方法 空心钉经皮手术内固定治疗老年股骨颈骨折62 例，男25 例，女37 例，年龄60～85 岁，平均68.65 岁。无移位骨折(GardenⅠ、Ⅱ型)28 例，移位骨折(GardenⅢ、Ⅳ型)34 例，随访时间8～74个月，平均36.4个月。观察内容包括受伤至手术的时间、移位程度、术后早期负重及与年龄的关系。结果 无移位股骨颈骨折，骨折不愈合及股骨头缺血坏死发生率为0，移位骨折，不愈合及股骨头缺血坏死分别占8.82％(3/34)和14.71％(5/34)。伤后至手术时间超过3周，骨折不愈合的发生率增高至50％(1/2)。结论 如术前能掌握好适应证，术后给予正确的康复指导，内固定治疗老年人股骨颈骨折大多数效果良好。 【关键词】 老年；股骨颈骨折；内固定；空心钉 　　Femoral Neck Fracture Treatment by Cannulated Screw Internal Fixation in Elderly Patients 　　Abstract：Objective To study the factors that influence the outcome of the femoral neck fractures after fixed by cannulated screws，and the possibility of internal fixation as one of the useful methods in the treatment of femoral neck fractures.Methods Sixtytwo elderly patients with femoral neck fractures were treated with percutaneous cannulated screw fixation.Their average age was 68.65 years(range，60～85years).Twentyeight cases were femoral neck fractures with no displace(GardenⅠ，Ⅱ).Thirtyfour cases were displaced(GardenⅢ，Ⅳ).The average follow up time was 36.40 months(8～74 months).The time to surgery，initial fracture displacement，weight bearing and age were recorded.Results The rate of nonunion and avascular necrosis was 0.00％ in the femoral neck fractures with no displace，while it was 8.82％(3/34) and 14.71％(5/34) respectively in the displaced femoral neck fractures，the nonunion rate increased to 50.00％ when the operation was delayed more than 3 weeks.Conclusion The outcome of internal fixation of femoral neck fractures is good in the majority of elderly patients.The indications should be mastered before operation and rehabil exercise guidance should be given postoperatively. 　　Key words：femoral neck fractures；internal fixation；cannulated screws 　　股骨颈是骨质疏松骨折的好发部位之一，严重影响老年患者的生活质量，病死率、骨折的不愈合率和股骨头坏死率仍较高。目前国际上对股骨颈骨折治疗原则已基本达成共识，即骨折内固定和关节置换，但具体治疗方案的选择、术后疗效评价及并发症的预防与治疗仍存在较大争议。我院自1998年8月至2004年8月采用空心钉内固定治疗62 例60 岁