上海交通大学学报（医学版）

上海交通大学学报（医学版）

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老年股骨转子间骨折患者骨量状况对内固定治疗效果的影响

徐瑞达1,2，傅晓东1,2，张玲1,2，韩晓峰1,2   

  1. 上海交通大学  医学院1.附属仁济医院南院骨科， 上海 201112； 2.附属仁济医院骨科, 上海 200127
  • 出版日期:2015-12-28 发布日期:2016-01-21
  • 作者简介:徐瑞达(1984—), 男, 住院医师, 硕士; 电子信箱: xuruida@renji.com。

Effect of the bone mass of old patients with intertrochanteric fracture on the internal fixation surgery

XU Rui-da1,2, FU Xiao-dong1,2, ZHANG Ling1,2, HAN Xiao-feng1,2   

  1. 1.Department of Orthopedics, Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine, Shanghai 201112, China； 2.Department of Orthopedics, Renji Hospital，Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2015-12-28 Published:2016-01-21

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摘要：

目的  探讨老年股骨转子间骨折患者骨质疏松程度对内固定手术治疗效果的影响。方法  接受髓内固定手术治疗的老年单侧股骨转子间骨折患者64例，术后检测健侧髋部骨密度了解患者术前髋部骨质疏松程度；其中骨量正常11例，骨量减少21例，骨质疏松32例，并据此将患者分为3组。根据Merle DAubigne和Salvati-Wilson两种髋关节功能评分评定患者术后髋关节功能，记录患者下地负重行走的时间。结果  64例患者均获得随访，随访时间为4~19个月。骨折愈合时间为（2.5±0.8）个月，下地负重行走时间为（2.6±0.7）个月。无骨折处感染、继发骨折、螺钉穿出股骨头和内固定断裂病例。按Merle D'Aubigne髋关节功能评分：优9例，良48例，中7例；按Salvati-Wilson髋关节功能评分：优8例，良49例，中7例。骨质疏松组患者髋关节功能评分明显低于其他两组（P<0.05）；各组在下地负重行走时间上的差异无统计学意义（P>0.05）。结论  老年股骨转子间骨折患者骨质疏松程度影响骨折的手术治疗效果。对于骨质疏松者，建议适当延迟下地负重行走时间。

关键词: 转子间骨折, 骨质疏松, 内固定

Abstract:

Objective  To explore the effect of osteoporosis of old patients with intertrochanteric fracture on the internal fixation surgery. Methods  A total of 64 old patients with ipsilateral intertrochanteric fracture who underwent intramedullary fixation surgery were enrolled. The osteoporosis of hips of patients before surgery was obtained by measuring the bone density of healthy hip after surgery. There were 11 patients with normal bone mass, 21 patients with osteopenia, and 32 patients with osteoporosis. Then patients were divided into 3 groups accordingly. The hip joint function of patients after surgery was evaluated by Merle D’Aubigne and Salvati-Wilson hip joint function scales, and the time of being able to walk was recorded. Results  All 64 patients were followed up for 4-19 months. The healing time was (2.5±0.8) months and the time of being able to walk was (2.6±0.7) months. No cases of infection at fracture site, secondary fracture, nail penetration, or fixation breakage were found. According to the Merle D’Aubigne hip joint function scale, 9 cases were excellent, 48 cases were good, and 7 cases were passable. According to the Salvati-Wilson hip joint function scale, 8 cases were excellent, 49 cases were good, and 7 cases were passable. Scores of hip joint function of osteoporosis group were significantly lower than those of other two groups (P<0.05). The difference of the time of being able to walk among three groups was not statistically significant (P>0.05). Conclusion  The osteoporosis of old patients with intertrochanteric fracture influences the therapeutic effect of surgical treatment. For patients with osteoporosis, it is recommended to postpone the time of walk.

Key words: intertrochanteric fracture, osteoporosis, internal fixation