中国组织工程研究Issue(48)：8429-8436,8.DOI:10.3969/j.issn.2095-4344.2013.48.021
老年骨质疏松性髋部骨折的优化治疗方案
Optimized surgical treatment for osteoporotic hip fractures in the elderly
摘要
Abstract
BACKGROUND:Active surgical treatments are preferred for elderly hip fractures. Individual fixation method is chosen according to fracture site, type, age and whether there are basic diseases in internal medicine, which plays an important role in the successful treatment of elderly hip fractures. <br> OBJECTIVE:To explore the effects of optimized surgical treatment on osteoporotic hip fracture in the elderly. <br> METHODS: Totally 176 patients with osteoporotic hip fracture were treated by different methods between January 2000 and January 2012, including 63 males and 113 females, with a mean age of (76.7±6.3) years. Out of the 84 cases of interchanteric fracture, seven cases were treated with conservative methods, 34 cases were treated with dynamic hip screw internal fixation, 18 cases were treated with cannulated screw internal fixation, seven cases were treated with anatomical plate internal fixation, 12 cases were treated with bipolar femoral placement, and six cases were treated with total hip arthroplasty. Out of the 92 cases with femoral neck fractures, 40 cases were treated with bipolar femoral placement, 37 cases were treated with total hip arthroplasty and 15 cases were treated with cannulated screw internal fixation. Modified Harris hip function scores were used to evaluate the therapeutic effects of different treatment methods. Complications were observed. <br> RESULTS AND CONCLUSION:Seventy-six cases of interchanteric fractures and 85 cases of femoral neck fractures were fol owed-up for 8-26 months with an average of (5.7±1.3) months. Three cases suffered from post-operative infection, and one case died due to cardio-pulmonary failure in 10 days after operation. Both intraoperation and postoperative complications included femoral head cutting, intraoperative fracture, internal fixation and prosthetic loosening, postoperative fracture, avascular necrosis of femoral head, coxa vara, legs shorten, and delayed fracture healing. The incidence rates of complications in patients undergoing bipolar femoral placement and total hip arthroplasty were significantly lower than those treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P<0.05). The outcomes of the treatment according to Harris scoring criterion were better in patients treated with bipolar femoral placement and total hip arthroplasty than in patients treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P<0.05). No significant differences were found in the incidence rate of complications and Harris scores among patients treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P>0.05). No significant differences were found in the incidence rate of complications and Harris scores between patients treated with bipolar femoral placement and total hip arthroplasty (P>0.05). These findings indicate that the treatment of osteoporotic hip fracture in the elderly can achieve satisfactory results if the comprehensive therapies are given. Bipolar femoral placement and total hip arthroplasty are preferred for elderly femoral neck fractures.关键词
骨关节植入物/骨与关节临床实践/骨质疏松/髋部骨折/手术/内固定/老年/综合治疗/省级基金分类
医药卫生引用本文复制引用
陈鹏,陈家玉,刘文和,颜林淋,郭志文,唐新文,胡伟文,曹锡文,王福剑,李杨..老年骨质疏松性髋部骨折的优化治疗方案[J].中国组织工程研究,2013,(48):8429-8436,8.基金项目
湖南省科技厅立项支助项目(2012TP4021-4)；郴州市科技局立项支助项目(2012CT116)@@@@the Supportive Program of Hunan Provincial Science and Technology Bureau, No.2012TP4021-4 （2012TP4021-4）
the grant from the Science and Technology Department of Chenzhou City, No.2012CT116 （）
