多功能外固定支架治疗老年股骨粗隆间骨折

【】　目的　探讨多功能外固定支架治疗老年股骨粗隆间骨折的疗效和优点。　方法　2007年7月-2009年10月，采用外固定架治疗28例老年股骨粗隆间骨折患者，其中男11例，女17例；年龄74~91岁，平均81岁。致伤原因摔伤25例，交通事故伤3例。骨折按Evans分型Ⅰ型1例，Ⅲ型15例，Ⅳ型12例。受伤至手术时间2~7d。　结果　术后患者切口均Ⅰ期愈合，无延迟愈合及其他早期并发症发生。28例均获随访，随访时间5~14个月，平均9个月。X线片示骨折全部愈合，愈合时间11～24周，平均17周。无髋内翻和下肢短缩等并发症发生。术后3个月，采用Harris评分进行功能评价，优18例，良7例，差3例，优良率89.3%。出现轻度针道感染7例，中度5例，重度2例，针道感染率50%；合并糖尿病者2例出现中度针道感染，2例出现重度针道感染。重度者经局部换药、应用抗生素后愈合，后又反复出现，2~3个月取钉后愈合。无骨感染发生，患者均未出现褥疮，合并症无明显加重。　结论　外固定架治疗粗隆间骨折，手术创伤小，操作简便，符合生物力学原理，可以早期离床活动及早期骨折愈合。【Abstract】　Objective　Toexploretheeffectivenessandadvantagesofmultifunctionalexternalfixatorforthetreatmentoffemoralintertrochantericfracturesintheelderlypatients.　Methods　Twenty-eightpatientswithfemoralintertrochantericfracturesincluding11malesand17femalesreceivingexternalfixatortreatmentbetweenJuly2007andOctober2009wereenrolledinthisstudy.Theiragerangedfrom74to91yearsoldwiththeaveragetobe81years.Twenty-fivepatientshadthediseasebecauseofgroundfalls,andtheother3wereduetotrafficaccidents.BasedontheEvansTypeclassification,therewere1Type-Ⅰcase,15Type-Ⅲcases,and12Type-Ⅳcases.Thetimebetweeninjuryandsurgerywasrangedfrom2to7days.　Results　AllincisionsofthepatientshealedduringphaseⅠwithoutdelayedhealingorotherearlycomplications.Follow-upwasdonetoallthepatientsfor5to14months,averaging9months.X-rayshowedallfractureshealed,andthehealingtimerangedfrom11to24weekswithanaverageof17weeks.Novarusorlegshorteningorothercomplicationsoccurred.Threemonthsaftersurgery,basedontheHarrishipscoreforfunctionalevaluation,therewere18excellentcases,7goodcasesand3poorcaseswithaexcellentandgoodrateof89.3%.Mildpintractinfectionwasdetectedin7patients,moderatein5,andseverein2withatotalpintractinfectionrateof50%.Twopatientswithdiabetessufferingfromseverepintractinfectionrecoveredbylocalmedicationandantibiotics,buttheinfectionreoccurredrepeatedlytillthehealingnailsweretaken.Noboneinfectionofulcersoccurred,andtheexistingcomplicationswerenotaggravated.　Conclusion　Treatmentofintertrochantericfractureswithmultifunctionalexternalfixatorisminimallyinvasive,simple,andconsistentwithbiomechanicalprinciples,whichcanpromoteearlyactivitiesoutofbedandearlyfracturehealingforthepatients.