老年人骨质疏松性髋部骨折的治疗初探

目的探讨老年骨质疏松性髋部骨折的临床诊治方法及疗效。方法自2005年4月～2010年3月共治疗70岁以上（70—96岁）骨质疏松性髋部骨折100例，其中男39例，女61例。骨折类型：股骨颈骨折71例，股骨粗隆间骨折29例。其中手术治疗92例，保守治疗8例。其中股骨粗隆间骨折DHS内固定20例，保守治疗8例，人工股骨头置换1例；股骨颈骨折71例人工股骨头置换33例，全髋置换38例。本组患者同时配合抗骨质疏松药物治疗。结果本组所有患者手术顺利进行，术后伤口均一期愈合。本组100例获得随访，随访时间6月～28月，平均14．2月。术后股骨头缺血坏死4例，内固定物松动、滑脱5例、断裂2例，人工股骨头下沉致疼痛5例，脱位2例，精神症状2例。本组病例无肺栓塞、深静脉血栓形成、感染等并发症发生。术后5月，患者均能下地行走，生活自理。平均Harris评分由术前的（45．4±10．7）分恢复到术后1年的（91．5±7．2）分，术后与术前Harris评分比较t=21．1674，P〈0．05。x线片检查示内植物位置良好。结论老年骨质疏松性髋部骨折需要积极的以手术为主的综合治疗。

Treatment of osteoporotic hip fracture in the elder

Objective To explore the treatment of osteoporotie hip fracture in the elder. Methods One hundred patients over 70 years old （age ranging from 70 - 96） with osteoporotic hip fracture had been treated by surgery or no - operation from Apt 2003 to Mar 2010. There were 39 males and 61 females. The types of hip bone fracture had included femoral neck fracture 71 cases and femoral intertrochanteric fracture 29 cases. 92 patients had been treated by surgery. Eight cases were treated by non - operative methods. Out of 29 cases with femoral intertrochanteric, 20 cases had been treated by DHS internal fixation. Eight cases were treated by non - operative methods. One ease had been treated by replacement of artificial femoral head. Among 71 cases with femoral neck fracture, 33 cases had been treated by replacement of artificial femoral head, and 38 cases by total hip arthroplasty. All patients had been treated with antiosteoporotic drugs. Results The operations had been performed successfully, and the incision had healed well. All eases had been followed up with an average 14.2 months （ranged from 628 months）. 4 cases had suffered from femoral head ischemia and necrosis. The internal fixation loosening or slipping had happen in 5 cases. The break of internal fixation had occurred in 2 cases. 5 cases had suffered from pain caused by artificial femoral head sinking. The dislocation of hips had happened in 2 cases, and mental symptoms in 2 cases respectively. No other complications had happened in the series. All patients could walk independently without aiding and take care of themselves in 5 months post - operation. The pre - operation functional scores of hips averaged（45.4 ± 10.7）, and post- operation functional scores（91.5± 7.2） after one year post - operatively. The difference had statistical significance between post- operation functional scores of hips and pre -operation functional scores （ t = 21. 1674, P 〈 0.05 ）. The position of the implant components were radiographic satisfactory. Conclusion The treatment of osteoporotic hip fracture can achieve satisfactory results if the system therapies have been given basing on surgery in the eider.