【摘要】 目的 探討多功能外固定支架治療老年股骨粗隆間骨折的療效和優點。 方法 2007年7月-2009年10月，采用外固定架治療28例老年股骨粗隆間骨折患者，其中男11例，女17例；年齡74~91歲，平均81歲。致傷原因:摔傷25例，交通事故傷3例。骨折按Evans分型:Ⅰ型1例，Ⅲ型15例，Ⅳ型12例。受傷至手術時間2~7 d。 結果 術后患者切口均Ⅰ期愈合，無延遲愈合及其他早期并發癥發生。28例均獲隨訪，隨訪時間5~14個月，平均9個月。X線片示骨折全部愈合，愈合時間11～24周，平均17周。無髖內翻和下肢短縮等并發癥發生。術后3個月，采用Harris評分進行功能評價，優18例，良7例，差3例，優良率89.3%。出現輕度針道感染7例，中度5例，重度2例，針道感染率50%；合并糖尿病者2例出現中度針道感染，2例出現重度針道感染。重度者經局部換藥、應用抗生素后愈合，后又反復出現，2~3個月取釘后愈合。無骨感染發生，患者均未出現褥瘡，合并癥無明顯加重。 結論 外固定架治療粗隆間骨折，手術創傷小，操作簡便，符合生物力學原理，可以早期離床活動及早期骨折愈合。【Abstract】 Objective To explore the effectiveness and advantages of multifunctional external fixator for the treatment of femoral intertrochanteric fractures in the elderly patients. Methods Twenty-eight patients with femoral intertrochanteric fractures including 11 males and 17 females receiving external fixator treatment between July 2007 and October 2009 were enrolled in this study. Their age ranged from 74 to 91 years old with the average to be 81 years. Twenty-five patients had the disease because of ground falls, and the other 3 were due to traffic accidents. Based on the Evans Type classification, there were 1 Type-Ⅰ case, 15 Type-Ⅲ cases, and 12 Type-Ⅳ cases. The time between injury and surgery was ranged from 2 to 7 days. Results All incisions of the patients healed during phase Ⅰ without delayed healing or other early complications. Follow-up was done to all the patients for 5 to 14 months, averaging 9 months. X-ray showed all fractures healed, and the healing time ranged from 11 to 24 weeks with an average of 17 weeks. No varus or leg shortening or other complications occurred. Three months after surgery, based on the Harris hip score for functional evaluation, there were 18 excellent cases, 7 good cases and 3 poor cases with a excellent and good rate of 89.3%. Mild pin tract infection was detected in 7 patients, moderate in 5, and severe in 2 with a total pin tract infection rate of 50%. Two patients with diabetes suffering from severe pin tract infection recovered by local medication and antibiotics, but the infection reoccurred repeatedly till the healing nails were taken. No bone infection of ulcers occurred, and the existing complications were not aggravated. Conclusion Treatment of intertrochanteric fractures with multifunctional external fixator is minimally invasive, simple, and consistent with biomechanical principles, which can promote early activities out of bed and early fracture healing for the patients.
