田雅峰 刘士昭 姚兴豹 于健 任伟亮 李彦丽 王金榜 齐立卿

[摘要] 目的 探討闭合复位组合式外固定架治疗高危老年股骨粗隆间骨折的临床效果。 方法 选取河北省中医院骨伤科2012年5月～2016年5月收治的60岁以上患者92例作为研究对象，采用随机数字表法分为治疗组和对照组，每组各46例，治疗组采用手法牵引闭合复位组合式外固定架手术治疗，对照组采用骨牵引治疗。术后均随访6个月。比较两组Harris评分及并发症发生率。 结果 治疗组Harris评分高于对照组，并发症发生率低于对照组，差异均有统计学意义（P < 0.05）。 结论 闭合复位组合式外固定架手术治疗高龄股骨粗隆间骨折效果较好，可以降低术后并发症发生率，对于手术耐受力差、内科疾病较多的高龄患者具有较大优势，值得临床推广应用。

[关键词] 老年；股骨粗隆间骨折；组合式外固定架；闭合复位；骨牵引

[中图分类号] R683.42 [文献标识码] A [文章编号] 1673-7210（2018）02（c）-0063-04

Clinical effect of closed reduction combined with external fixaton in the treatment of intertrochanteric fracture of femur in high risk elderly

TIAN Yafeng1 LIU Shizhao2 YAO Xingbao1 YU Jian1 REN Weiliang3 LI Yanli4 WANG Jinbang3 QI Liqing3

1.First Department of Orthopaedic， Hebei Provincial Hospital of Chinese Medicine， Hebei Province， Shijiazhuang 050011， China； 2.Emergency Department， Hebei Provincial Hospital of Chinese Medicine， Hebei Province， Shijiazhuang 050011， China； 3. Third Department of Orthopaedic， Hebei Provincial Hospital of Chinese Medicine， Hebei Province， Shijiazhuang 050011， China； 4.Operation Room， Hebei Provincial Hospital of Chinese Medicine， Hebei Province， Shijiazhuang 050011， China

[Abstract] Objective To explore the clinical effect of the closed reduction combined with external fixaton in the treatment of intertrochanteric fracture of femur in high risk elderly. Methods From May 2012 to May 2016， 92 patients with femoral intertrochanteric fracture over 60 years old treated in Hebei Provincial Hospital of Traditional Chinese Medicine were divided into the treatment group and the control group by random number table， with 46 cases in each group. The treatment group was given closed reduction combined with external fixaton and the control group was given skeletal traction， both of them were followed up for 6 months after operation. The Harris score and the incidence of complications were compared between the two groups. Results The Harris score in the treatment group was higher than that of control group， the incidence of complications in the treatment group was lower than that of control group， with statistically significant differences （P < 0.05）. Conclusion The clinical effect of the closed reduction combined with external fixaton in the treatment of intertrochanteric fracture of femur in high risk elderly is good. It can reduce the incidence of complications. The advantages are appropriate for elderly patients who are poor tolerance for surgery and with more internal medical diseases. It is worthy of clinical promotion and application.

[Key words] Elderly； Femoral intertrochanteric fracture； Combined external fixator； Closed reduction； Skeletal traction

股骨粗隆間骨折是髋部骨折中的常见骨折，该骨折发生在股骨颈基底部至股骨小粗隆水平之间。对于高龄患者而言，股骨粗隆部是骨量丢失最严重的部位之一[1]。粗隆间骨折在临床上是高龄患者的常见创伤疾病，随着老龄社会的到来，其发病率呈逐年增高的趋势。据统计，股骨粗隆间骨折约占髋关节骨折的45%，其中不稳定性骨折占35%～45%[2]。老年患者的粗隆间骨折通常发生在骨质疏松的基础上，患者平均年龄在60岁以上，女性高于男性[3]，高龄患者常有心脑血管及其他严重内科系统疾病，骨折时虽出血多、愈合能力强，但高龄患者长期卧床引起的并发症较多，病死率为15%～20%[4]。高龄患者手术耐受力差，而股骨粗隆部骨量丢失又最严重，故创伤小、固定可靠的手术方式是临床医生的首选。……