股骨转子间骨折治疗失败原因分析及处理对策探析.docVIP

股骨转子间骨折治疗失败原因分析及处理对策探析 　 【摘要】 目的 分析股骨转子间骨折在临床治疗失败的原因，探讨其治疗失败前后的处理对策。方法 回顾总结自1999年1月～2005年6月期间治疗失败病例12例，平均年龄84.5岁，其中Evans-Jensen分型ⅡA型3例，ⅡB型5例，Ⅲ型4例；Singh指数，IV级1例，Ⅲ级4例，Ⅱ级5例，Ⅰ级2例；非手术治疗2例，手术治疗10例，失败后8例获再次手术治疗，全部病例均获随访。结果 8例获重行手术治疗，功能恢复良好，2例非手术治疗呈畸形愈合，2例死亡。结论 高龄、骨质疏松、严重粉碎等不稳定类型的股骨转子间骨折是容易导致失败的内在原因，与非手术治疗不重视、术前、术中准备不充分、内固定的选择及操作技术不当、术后护理及指导功能不恰当等外在因素有关。充分认识其病理特点、准确地掌握适应证、高度重视非手术治疗、合理运用内固定技术、加强术后的护理工作、科学指导功能锻炼是降低对难治性股骨转子间骨折治疗失败的有效措施。 【关键词】 股骨转子间骨折；失败原因；内固定；骨质疏松 【Abstract】 Objective To analyze the failure reasons of the clinical treatment of intertrochanteric fracture and discuss the handle methods after the failed treatment.Methods 12 failed cases were concluded from January 1999 to June 2005，which averaging 84.5 years. In Evans-Jensen type classification，there are 3 cases of type ⅡA，5 cases of type ⅡB，and 4 cases of type Ⅲ. According to Singh Index classification，there are 1 case of Index Ⅳ，4 cases of Index Ⅲ，5 cases of Index Ⅱ，and 2 cases of Index I. Besides，2 cases were treated by non-operation，10 cases were treated by operation. 8 cases were operated again after defeat. All the patients were followed up.Results 8 cases were operated again and obtained good results，while 2 cases got deformity reunion which were treated by non-operation. 2 cases died. Conclusion The unstable types of intertrochanteric fracture，such as elder patients，osteoporsis and severe comminuted are the internal reasons for the failure. As to the external reasons，they are little considering in non-operation，bad preparation for pre- operation and operating，wrong decision to the fixation，poor operative skill，carelessness after operation and the wrong way in doing exercises. The effective solution methods are to grasp the pathological specialty of the fracture，to master the operation adaptation，to respect the non-operation，to use fixation reasonable，to be more careful after operation and to help the patients doing exercises. 【Key words】 intertrochanteric fracture；failure reasons；internal fixation；