目的 回顧分析不同內固定方式對老年股骨粗隆間骨折的臨床療效。 方法 1999年3月－2009年5月采用內固定手術治療121例股骨粗隆間骨折患者，根據內固定方式不同分為4組：動力髖螺釘（DHS；A組43例）、經皮加壓鋼板（PCCP；B組19例）、股骨近端髓內釘（PFN；C組27例）、Gamma釘（D組32例）。4組患者年齡、骨折類型（Tronzo-Evans分型）等一般資料比較差異無統計學意義（P＞0.05），具有可比性。記錄手術時間、術中出血量及術后引流量、術中術后并發癥、骨折臨床愈合時間、術后髖關節功能恢復程度，比較評價各組臨床療效。 結果 術后各組患者切口均Ⅰ期愈合，無傷口感染等早期并發癥發生。患者均獲隨訪，隨訪時間18～108個月，平均56.4個月。與A組比較，B、C、D組手術時間明顯縮短，術中出血量及術后引流量減少，骨折愈合時間縮短，差異均有統計學意義（P＜0.01），A組較差；B、C、D各組間兩兩比較差異無統計學意義（P＞0.05）。術后并發癥發生率A組較高，與其余各組比較差異有統計學意義（P＜0.05）。末次隨訪時各組髖關節功能Harris評分比較差異無統計學意義（P＞0.05）。 結論 B、D組及C組3種手術方法在治療老年患者股骨粗隆間骨折具有創傷小、并發癥少等優勢，與A組法比較更有利于老年患者術后康復，但應注意骨折的良好復位及內固定物位置。
Objective To summarize the cl inical characteristics of 596 patients with fracture in Wenchuan earthquake and to investigate the therapeutic methods and effects of early treatment. Methods From May 12th 2008 to May 21st 2008, 596 patients with fracture caused by Wenchuan earthquake were treated, including 283 males and 313 females aged1.9-102 years (median 43 years). The time from injury to hospital ization varied from 12 minutes to 4 days. There were 132 cases of upper extremity fracture, 496 cases lower extremity fracture, 10 cases clavicular fracture, 16 cases scapular fracture, 23 cases pelvis fracture, and 59 cases spinal fracture. Among them, 183 cases were open fracture and 413 cases were closed fracture. And 214 cases had multiple fracture (35.9%) and 68 cases had crush injury in l imbs which scored (6.84 ± 2.48) points according to the mangled extremity severity score (MESS). Thirty-six cases were combined with neurovascular injury. The wound of the open fracture was contaminated at different degrees, but no gas gangrene was observed. Open fracture was treated with suturing or no suturing after debridement, open reduction and internal or external fixation. Closed fracture was fixed with spl ints, cast and traction. Forty-nine patients whom were highly suspected as osseous fascia compartment syndrome received incision decompression timely, and 34 patients whose MESS were above 7.0 points or suffering from crush injury of l ifethreatening systemic symptoms received amputation. Results Apart from 34 patients receiving amputation, 460 patients achieved functional reduction of fracture after manipulative reduction and 102 cases got satisfactory reduction after surgery. Postoperatively, 289 patients were transferred to other hospitals. Among the rest 307 patients, 34 with severe wound infection were healed after multiple debridement, anti-infection, and skin flap transplantation (16 cases healed by first intention and 18 cases healed by second intention), 42 cases with crush syndrome were treated with open decompression and amputation, and nodeep venous thrombosis of lower l imb, stress ulcer and death were observed after operation (29 cases healed by first intention and 13 cases healed by second intention). Conclusion By aiming at the features of fracture caused by earthquake, the prompt and professional treatment can achieve good therapeutic effects.