股骨粗隆间骨折治疗方法选择(1)
[摘要] 目的 总结不同内固定治疗股骨粗隆间骨折的选择原则。方法 随机选择该院2011年1月—2016年12月收治的53例股骨粗隆间骨折患者为研究对象，根据患者年龄、骨折类型、股骨髓腔大小、预期寿命，分别选择股骨近端髓内钉、股骨近端解剖型钢板、动力髋加防旋螺钉、骨水泥型人工股骨头置换。对1～2型选用动力髋加防旋螺钉固定;对年轻、骨质质量好、股骨髓腔狭窄患者选用股骨近端解剖钢板;对偏股骨颈基底、预期寿命短、合并疾病多的患者选择加长型骨水泥型人工股骨头置换术;对偏粗隆下、预期寿命长患者选择股骨近端髓内钉。结果 该组患者均获随访，1例患者死于围手术期，死因为肺栓塞;1例PFNA内固定，发生股骨颈内叶片状主钉松脱;3例发生髋内翻畸形。其余患者骨性愈合，恢复行走功能。结论 根据不同骨折类型，结合患者年龄、股骨髓腔大小，选择不同治疗方法，治疗股骨粗隆间骨折，可以取得良好治疗效果。
[关键词] 股骨粗隆间骨折;骨水泥型人工股骨头置换;动力髋加防旋螺钉;股骨近端髓内钉
[Abstract] Objective To summarize the selection principles of different internal fixation for intertrochanteric fractures. Methods 53 cases of intertrochanteric fractures of femur treated in the hospital from January 2011 to December 2016 were conveniently selected. According to the patient's age， fracture type， femoral bone marrow cavity size， life expectancy， the proximal femoral intramedullary nail and femoral proximal end anatomic steel plate， dynamic hip with anti-rotation screw， cemented artificial femoral head replacement. Methods For the type 1-2， dynamic hips and anti-rotation screws were used. For young， good bone quality and femoral bone marrow stenosis， the proximal femoral anatomical plate was selected. For the femoral neck base， the life expectancy is short and the patients with complicated disease chose extended cemented artificial femoral head replacement. For patients with long life expectancy， the proximal femur intramedullary nail was selected. Results All patients in this group were followed up. One patient died during perioperative period， died of pulmonary embolism， one case had PFNA internal fixation， lobular main nail loosening occurred in femoral neck， and three cases had hip varus deformity. The rest of the patients healed bones and recovered walking function. Conclusion According to different fracture types， combined with the patient's age and the size of the femoral bone marrow cavity， different treatment methods can be selected to treat femoral intertrochanteric fractures， which can achieve good results.
[Key words] Femoral intertrochanteric fracture; Cemented artificial femoral head replacement; Powered hip plus anti-rotation screw; Proximal femoral intramedullary nail
老年人群最為常见的创伤是股骨粗隆间骨折。非手术治疗股骨粗隆间骨折患者并发症多且治疗效果不佳，所以临床主张手术治疗，而选择合适的内固定术式是临床研究重点。股骨粗隆间骨折患者手术成功关键因素在于：①骨骼质量;②骨折复位质量;③骨折类型;④内固定物在骨骼中的具体放置位置(内固定物的选择尤为重要);⑤内固定物的设计。内固定物的选择主要取决于股骨矩的完整性，股骨矩决定了骨折稳定性。不稳定股骨粗隆间骨折的股骨矩不够完整，骨折复位后稳定性主要依赖于内固定加以维持[1]。目前来看，治疗股骨粗隆间骨折患者的主要方法有以下几种：①动力髋加防旋螺钉固定术;②股骨近端解剖型钢板术;③骨水泥型人工股骨头置换术;④股骨近端髓内钉术。多数学者认为，内固定是治疗股骨粗隆间骨折患者的首选方式[2]。髓外固定以动力髋加防旋螺钉组手术和股骨近端解剖型钢板术为代表，股骨颈内螺钉抗张应力相比髓内固定较弱，因此未完全符合生物力学固定要求，极易导致固定失败[3]。髓内固定比较符合生物力学特点，但是，临床上并不是所有患者均适宜用髓内固定，对某些特殊病例，选择动力髋、股骨近端解剖钢板及骨水泥型人工股骨头置换术，该研究以该院于2011年1月—2016年12月收治的53例股骨粗隆间骨折患者为对象展开研究，现报道如下。, http://www.100md.com(宋国生)
[关键词] 股骨粗隆间骨折;骨水泥型人工股骨头置换;动力髋加防旋螺钉;股骨近端髓内钉
[Abstract] Objective To summarize the selection principles of different internal fixation for intertrochanteric fractures. Methods 53 cases of intertrochanteric fractures of femur treated in the hospital from January 2011 to December 2016 were conveniently selected. According to the patient's age， fracture type， femoral bone marrow cavity size， life expectancy， the proximal femoral intramedullary nail and femoral proximal end anatomic steel plate， dynamic hip with anti-rotation screw， cemented artificial femoral head replacement. Methods For the type 1-2， dynamic hips and anti-rotation screws were used. For young， good bone quality and femoral bone marrow stenosis， the proximal femoral anatomical plate was selected. For the femoral neck base， the life expectancy is short and the patients with complicated disease chose extended cemented artificial femoral head replacement. For patients with long life expectancy， the proximal femur intramedullary nail was selected. Results All patients in this group were followed up. One patient died during perioperative period， died of pulmonary embolism， one case had PFNA internal fixation， lobular main nail loosening occurred in femoral neck， and three cases had hip varus deformity. The rest of the patients healed bones and recovered walking function. Conclusion According to different fracture types， combined with the patient's age and the size of the femoral bone marrow cavity， different treatment methods can be selected to treat femoral intertrochanteric fractures， which can achieve good results.
[Key words] Femoral intertrochanteric fracture; Cemented artificial femoral head replacement; Powered hip plus anti-rotation screw; Proximal femoral intramedullary nail
老年人群最為常见的创伤是股骨粗隆间骨折。非手术治疗股骨粗隆间骨折患者并发症多且治疗效果不佳，所以临床主张手术治疗，而选择合适的内固定术式是临床研究重点。股骨粗隆间骨折患者手术成功关键因素在于：①骨骼质量;②骨折复位质量;③骨折类型;④内固定物在骨骼中的具体放置位置(内固定物的选择尤为重要);⑤内固定物的设计。内固定物的选择主要取决于股骨矩的完整性，股骨矩决定了骨折稳定性。不稳定股骨粗隆间骨折的股骨矩不够完整，骨折复位后稳定性主要依赖于内固定加以维持[1]。目前来看，治疗股骨粗隆间骨折患者的主要方法有以下几种：①动力髋加防旋螺钉固定术;②股骨近端解剖型钢板术;③骨水泥型人工股骨头置换术;④股骨近端髓内钉术。多数学者认为，内固定是治疗股骨粗隆间骨折患者的首选方式[2]。髓外固定以动力髋加防旋螺钉组手术和股骨近端解剖型钢板术为代表，股骨颈内螺钉抗张应力相比髓内固定较弱，因此未完全符合生物力学固定要求，极易导致固定失败[3]。髓内固定比较符合生物力学特点，但是，临床上并不是所有患者均适宜用髓内固定，对某些特殊病例，选择动力髋、股骨近端解剖钢板及骨水泥型人工股骨头置换术，该研究以该院于2011年1月—2016年12月收治的53例股骨粗隆间骨折患者为对象展开研究，现报道如下。, http://www.100md.com(宋国生)
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