老年人股骨轉子間骨折國內外治療進展_《華西醫學》

作者：

李沁 ,  劉雷 , 欒富均

四川大學華西醫院骨科（成都，610041）;

關鍵詞：

老年人股骨轉子間骨折內固定

DOI：

10.7507/1002-0179.20130410

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股骨轉子間骨折臨床多發，多見于老年人。保守治療時間長，并發癥多，病死率高；現在臨床上已對采取手術治療達成共識，手術治療縮短臥床時間，并降低由此帶來的并發癥發生率及病死率，早期功能鍛煉促進功能康復。本文就近年來國內外對老年人股骨轉子間骨折治療進展作一綜述。

引用本文： 李沁,劉雷,欒富均. 老年人股骨轉子間骨折國內外治療進展. 華西醫學, 2013, 28(8): 1303-1307. doi: 10.7507/1002-0179.20130410 復制

1.	Kannus P, Parkkari J, Sievänen H, et al. Epidemiology of hip fractures [J]. Bone, 1996, 18(Suppl 1): 57-63.
2.	Horowitz BG. Retrospective analysis of hip fractures[J]. Surg Gynecol Obstet, 1966, 123(3): 565-570.
3.	Chinoy MA, Parker MJ. Fixed nail plates versus sliding hip systems for the treatment of trochanteric femoral fractures: a meta analysis of 14 studies[J]. Injury, 1999, 30(3): 157-163.
4.	Chirodian N, Arch B, Parker MJ. Sliding hip screw fixation of trochanteric hip fractures: outcome of 1024 procedures[J]. Injury, 2005, 36(6): 793-800.
5.	章柏平, 盧海峰, 湯善華. Gamma釘和動力髖螺釘內固定治療股骨轉子間骨折臨床療效比較[J]. 臨床骨科雜志, 2012, 15(1): 73-75.
6.	胡煒, 裘超, 高金華, 等. 第三代Gamma釘與動力髖螺釘(DHS)治療老年股骨粗隆間骨折的療效比較[J]. 中國骨與關節損傷雜志, 2011, 26(10): 922-923.
7.	Haidukewych GJ, Israel TA, Berry DJ. Reverse obliquity fractures of the intertrochanteric region of the femur[J]. J Bone Joint Surg Am, 2001, 83-A(5): 643-650.
8.	Brammar TJ, Kendrew J, Khan RJ, et al. Reverse obliquity and transverse fractures of the trochanteric region of the femur: a review of 101 cases[J]. Injury, 2005, 36(7): 851-857.
9.	Kuzyk PR, Lobo J, Whelan D, et al. Biomechanical evaluation of extramedullary versus intramedullary fixation for reverse obliquity intertrochanteric fractures[J]. J Orthop Trauma, 2009, 23(1): 31-38.
10.	Schipper IB, Marti RK, Van der Werken C. Unstable trochanteric femoral fractures:extramedullary or intramedullary fixation. Review of literature[J]. Injury, 2004, 35(2): 142-151.
11.	Butt MS, Krikler SJ, Nafie S, et al. Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial[J]. Injury, 1995, 26(9): 615-618.
12.	Radford PJ, Needoff M, Webb JK. A prospective randomised comparison of the dynamic hip screw and the gamma locking nail[J]. J Bone Joint Surg Br, 1993, 75(5): 789-793.
13.	Bridle SH, Patel AD, Bircher M, et al. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw[J]. J Bone Joint Surg Br, 1991, 73(2): 330-334.
14.	Simmermacher RK, Bosch AM, Van der Werken C. The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures[J]. Injury, 1999, 30(5): 327-332.
15.	Herrera A, Domingo LJ, Calvo A, et al. A comparative study of trochanteric fractures treated with the Gamma nail or the proximal femoral nail[J]. Int Orthop, 2002, 26(6): 365-369.
16.	郭慶翔, 傅萬軍, 楊運發. 應用PFN治療老年人不穩定型股骨轉子間骨折[J]. 廣州醫藥, 2012, 43(4): 17-19.
17.	張業祥, 鹿霞, 張濤, 等. DHS、PFN內固定術治療老年股骨轉子間骨折療效對比觀察[J]. 山東醫藥, 2011, 51(30): 65-66.
18.	Windolf J, Hollander DA, Hakimi M, et al. Pitfalls and complications in the use of the proximal femoral nail[J]. Langenbecks Arch Surg, 2005, 390(1): 59-65.
19.	Wm G, Salphale YS. Proximal femoral nail-an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year[J]. Int Orthop, 2007, 31(3): 403-408.
20.	Fogagnolo F, Kfuri M, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail[J]. Arch Orthop Trauma Surg, 2004, 124(1): 31-37.
21.	Saudan M, Lübbeke A, Sadowski C, et al. Pertrochanteric fractures: is there an advantage to an intramedullary nail? a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail[J]. J Orthop Trauma, 2002, 16(6): 386-393.
22.	Strauss E, Frank J, Lee J, et al. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation[J]. Injury, 2006, 37(10): 984-989.
23.	Windolf M, Braunstein V, Dutoit C, et al. Is a helical shaped implant a superior alternative to the dynamic hip screw for unstable femoral neck fractures? a biomechanical investigation[J]. Clin Biomech (Bristol, Avon), 2009, 24(1): 59-64.
24.	Windolf M, Muths R, Braunstein V, et al. Quantification of cancellous bone-compaction due to DHS Blade insertion and influence upon cut-out resistance[J]. Clin Biomech (Bristol, Avon), 2009, 24(1): 53-58.
25.	Mereddy P, Kamath S, Ramakrishnan M, et al. The AO/ASIF proximal femoral nail antirotation(PFNA): a new design for the treatment of unstable proximal femoral fractures[J]. Injury, 2009, 40(4): 428-432.
26.	吳崗, 方躍, 裴福興, 等. PFNA治療老年股骨轉子間骨折29例體會[J]. 華西醫學, 2009, 24(6): 1539-1541.
27.	Liu Y, Tao R, Liu F, et al. Mid-term outcomes after intramedullary fixation of peritrochanteric femoral fractures using the new proximal femoral nail antirotation (PFNA)[J]. Injury, 2010, 41(8): 810-817.
28.	梁春雨, 張柳, 平少華, 等. 應用股骨近端髓內釘與動力髖(髁)螺釘治療老年股骨轉子間骨折的對比分析[J]. 中國矯形外科雜志, 2011, 19(24): 2038-2040.
29.	呂濤, 賈曉軍. PFNA與DHS應用于股骨轉子間骨折內固定的比較[J]. 吉林醫學, 2012, 33(10): 2054-2055.
30.	Hwang JH, Oh JK, Han SH, et al. Mismatch between PFNa and medullary canal causing difficulty in nailing of the pertrochanteric fractures[J]. Arch Orthop Trauma Surg, 2008, 128(12): 1443-1446.
31.	Pu JS, Liu L, Wang GL, et al. Results of the proximal femoral nail anti-rotation (PFNA) in elderly Chinese patients[J]. Int Orthop, 2009, 33(5): 1441-1444.
32.	王華, 樊仕才, 葉書熙, 等. 亞洲型股骨近端防旋髓內釘治療老年股骨轉子間骨折體會[J]. 創傷外科雜志, 2012, 14(1): 42-44.
33.	陸晴友, 李增春, 李國風, 等. PFNA及PFNAⅡ治療股骨轉子間骨折療效分析[J]. 國際骨科學雜志, 2011, 32(1): 54-56.
34.	Kammerlander C, Gebhard F, Meier C, et al. Standardised cement augmentation of the PFNA using a perforated blade: a new technique and preliminary clinical results. A prospective multicentre trial[J]. Injury, 2011, 42(12): 1484-1490.
35.	廖濤, 倪衛東, 趙光榮, 等. 外固定支架治療老年股骨轉子間骨折[J]. 重慶醫科大學學報, 2011, 36(2): 216-217.
36.	Tomak Y, Kocaoglu M, Piskin A, et al. Treatment of intertrochanteric fractures in geriatric patients with a modified external fixator[J]. Injury, 2005, 36(5): 635-643.
37.	Petsatodis G, Maliogas G, Karikis J, et al. External fixation for stable and unstable intertrochanteric fractures in patients older than 75 years of age: a prospective comparative study[J]. J Orthop Trauma, 2011, 25(4): 218-223.
38.	Bonnevialle P, Saragaglia D, Ehlinger M, et al. Trochanteric locking nail versus arthroplasty in unstable intertrochanteric fracture in patients aged over 75 years[J]. Orthop Traumatol Surg Res, 2011, 97(6 Suppl): S95-100.
39.	唐際存, 王梨明, 胡譯文, 等. 矩形柄人工髖關節置換治療老年股骨轉子間粉碎性骨折[J]. 中國修復重建外科雜志, 2011, 25(11): 1400-1402.
40.	Tang P, Hu F, Shen J, et al. Proximal femoral nail antirotation versus hemiarthroplasty: a study for the treatment of intertrochanteric fractures[J]. Injury, 2012, 43(6): 876-881.
41.	Mortazavi SM, R Greenky M, Bican O, et al. Total hip arthroplasty after prior surgical treatment of hip fracture is it always challenging?[J]. J Arthroplasty, 2012, 27(1): 31-36.
42.	Zhang B, Chiu KY, Wang M. Hip arthroplasty for failed internal fixation of intertrochanteric fractures[J]. J Arthroplasty, 2004, 19(3): 329-333.
43.	Bansal R, Luscombe J, Cooper JP. Post-operative mortality related to waiting time for hip fracture surgery[J]. Injury, 2005, 36(8): 984.
44.	Khan SK, Kalra S, Khanna A, et al. Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291, 413 patients[J]. Injury, 2009, 40(7): 692-697.
45.	Tang X, Liu L, Yang TF, et al. Preliminary effect of proximal femoral nail antirotation on emergency treatment of senile patients with intertrochanteric fracture[J]. Chin J Traumatol, 2010, 13(4): 212-216.

1. 　Kannus P, Parkkari J, Sievänen H, et al. Epidemiology of hip fractures [J]. Bone, 1996, 18(Suppl 1): 57-63.
2. 　Horowitz BG. Retrospective analysis of hip fractures[J]. Surg Gynecol Obstet, 1966, 123(3): 565-570.
3. 　Chinoy MA, Parker MJ. Fixed nail plates versus sliding hip systems for the treatment of trochanteric femoral fractures: a meta analysis of 14 studies[J]. Injury, 1999, 30(3): 157-163.
4. 　Chirodian N, Arch B, Parker MJ. Sliding hip screw fixation of trochanteric hip fractures: outcome of 1024 procedures[J]. Injury, 2005, 36(6): 793-800.
5. 　章柏平, 盧海峰, 湯善華. Gamma釘和動力髖螺釘內固定治療股骨轉子間骨折臨床療效比較[J]. 臨床骨科雜志, 2012, 15(1): 73-75.
6. 　胡煒, 裘超, 高金華, 等. 第三代Gamma釘與動力髖螺釘(DHS)治療老年股骨粗隆間骨折的療效比較[J]. 中國骨與關節損傷雜志, 2011, 26(10): 922-923.
7. 　Haidukewych GJ, Israel TA, Berry DJ. Reverse obliquity fractures of the intertrochanteric region of the femur[J]. J Bone Joint Surg Am, 2001, 83-A(5): 643-650.
8. 　Brammar TJ, Kendrew J, Khan RJ, et al. Reverse obliquity and transverse fractures of the trochanteric region of the femur: a review of 101 cases[J]. Injury, 2005, 36(7): 851-857.
9. 　Kuzyk PR, Lobo J, Whelan D, et al. Biomechanical evaluation of extramedullary versus intramedullary fixation for reverse obliquity intertrochanteric fractures[J]. J Orthop Trauma, 2009, 23(1): 31-38.
10. 　Schipper IB, Marti RK, Van der Werken C. Unstable trochanteric femoral fractures:extramedullary or intramedullary fixation. Review of literature[J]. Injury, 2004, 35(2): 142-151.
11. 　Butt MS, Krikler SJ, Nafie S, et al. Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial[J]. Injury, 1995, 26(9): 615-618.
12. 　Radford PJ, Needoff M, Webb JK. A prospective randomised comparison of the dynamic hip screw and the gamma locking nail[J]. J Bone Joint Surg Br, 1993, 75(5): 789-793.
13. 　Bridle SH, Patel AD, Bircher M, et al. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw[J]. J Bone Joint Surg Br, 1991, 73(2): 330-334.
14. 　Simmermacher RK, Bosch AM, Van der Werken C. The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures[J]. Injury, 1999, 30(5): 327-332.
15. 　Herrera A, Domingo LJ, Calvo A, et al. A comparative study of trochanteric fractures treated with the Gamma nail or the proximal femoral nail[J]. Int Orthop, 2002, 26(6): 365-369.
16. 　郭慶翔, 傅萬軍, 楊運發. 應用PFN治療老年人不穩定型股骨轉子間骨折[J]. 廣州醫藥, 2012, 43(4): 17-19.
17. 　張業祥, 鹿霞, 張濤, 等. DHS、PFN內固定術治療老年股骨轉子間骨折療效對比觀察[J]. 山東醫藥, 2011, 51(30): 65-66.
18. 　Windolf J, Hollander DA, Hakimi M, et al. Pitfalls and complications in the use of the proximal femoral nail[J]. Langenbecks Arch Surg, 2005, 390(1): 59-65.
19. 　Wm G, Salphale YS. Proximal femoral nail-an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year[J]. Int Orthop, 2007, 31(3): 403-408.
20. 　Fogagnolo F, Kfuri M, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail[J]. Arch Orthop Trauma Surg, 2004, 124(1): 31-37.
21. 　Saudan M, Lübbeke A, Sadowski C, et al. Pertrochanteric fractures: is there an advantage to an intramedullary nail? a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail[J]. J Orthop Trauma, 2002, 16(6): 386-393.
22. 　Strauss E, Frank J, Lee J, et al. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation[J]. Injury, 2006, 37(10): 984-989.
23. 　Windolf M, Braunstein V, Dutoit C, et al. Is a helical shaped implant a superior alternative to the dynamic hip screw for unstable femoral neck fractures? a biomechanical investigation[J]. Clin Biomech (Bristol, Avon), 2009, 24(1): 59-64.
24. 　Windolf M, Muths R, Braunstein V, et al. Quantification of cancellous bone-compaction due to DHS Blade insertion and influence upon cut-out resistance[J]. Clin Biomech (Bristol, Avon), 2009, 24(1): 53-58.
25. 　Mereddy P, Kamath S, Ramakrishnan M, et al. The AO/ASIF proximal femoral nail antirotation(PFNA): a new design for the treatment of unstable proximal femoral fractures[J]. Injury, 2009, 40(4): 428-432.
26. 　吳崗, 方躍, 裴福興, 等. PFNA治療老年股骨轉子間骨折29例體會[J]. 華西醫學, 2009, 24(6): 1539-1541.
27. 　Liu Y, Tao R, Liu F, et al. Mid-term outcomes after intramedullary fixation of peritrochanteric femoral fractures using the new proximal femoral nail antirotation (PFNA)[J]. Injury, 2010, 41(8): 810-817.
28. 　梁春雨, 張柳, 平少華, 等. 應用股骨近端髓內釘與動力髖(髁)螺釘治療老年股骨轉子間骨折的對比分析[J]. 中國矯形外科雜志, 2011, 19(24): 2038-2040.
29. 　呂濤, 賈曉軍. PFNA與DHS應用于股骨轉子間骨折內固定的比較[J]. 吉林醫學, 2012, 33(10): 2054-2055.
30. 　Hwang JH, Oh JK, Han SH, et al. Mismatch between PFNa and medullary canal causing difficulty in nailing of the pertrochanteric fractures[J]. Arch Orthop Trauma Surg, 2008, 128(12): 1443-1446.
31. 　Pu JS, Liu L, Wang GL, et al. Results of the proximal femoral nail anti-rotation (PFNA) in elderly Chinese patients[J]. Int Orthop, 2009, 33(5): 1441-1444.
32. 　王華, 樊仕才, 葉書熙, 等. 亞洲型股骨近端防旋髓內釘治療老年股骨轉子間骨折體會[J]. 創傷外科雜志, 2012, 14(1): 42-44.
33. 　陸晴友, 李增春, 李國風, 等. PFNA及PFNAⅡ治療股骨轉子間骨折療效分析[J]. 國際骨科學雜志, 2011, 32(1): 54-56.
34. 　Kammerlander C, Gebhard F, Meier C, et al. Standardised cement augmentation of the PFNA using a perforated blade: a new technique and preliminary clinical results. A prospective multicentre trial[J]. Injury, 2011, 42(12): 1484-1490.
35. 　廖濤, 倪衛東, 趙光榮, 等. 外固定支架治療老年股骨轉子間骨折[J]. 重慶醫科大學學報, 2011, 36(2): 216-217.
36. 　Tomak Y, Kocaoglu M, Piskin A, et al. Treatment of intertrochanteric fractures in geriatric patients with a modified external fixator[J]. Injury, 2005, 36(5): 635-643.
37. 　Petsatodis G, Maliogas G, Karikis J, et al. External fixation for stable and unstable intertrochanteric fractures in patients older than 75 years of age: a prospective comparative study[J]. J Orthop Trauma, 2011, 25(4): 218-223.
38. 　Bonnevialle P, Saragaglia D, Ehlinger M, et al. Trochanteric locking nail versus arthroplasty in unstable intertrochanteric fracture in patients aged over 75 years[J]. Orthop Traumatol Surg Res, 2011, 97(6 Suppl): S95-100.
39. 　唐際存, 王梨明, 胡譯文, 等. 矩形柄人工髖關節置換治療老年股骨轉子間粉碎性骨折[J]. 中國修復重建外科雜志, 2011, 25(11): 1400-1402.
40. 　Tang P, Hu F, Shen J, et al. Proximal femoral nail antirotation versus hemiarthroplasty: a study for the treatment of intertrochanteric fractures[J]. Injury, 2012, 43(6): 876-881.
41. 　Mortazavi SM, R Greenky M, Bican O, et al. Total hip arthroplasty after prior surgical treatment of hip fracture is it always challenging?[J]. J Arthroplasty, 2012, 27(1): 31-36.
42. 　Zhang B, Chiu KY, Wang M. Hip arthroplasty for failed internal fixation of intertrochanteric fractures[J]. J Arthroplasty, 2004, 19(3): 329-333.
43. 　Bansal R, Luscombe J, Cooper JP. Post-operative mortality related to waiting time for hip fracture surgery[J]. Injury, 2005, 36(8): 984.
44. 　Khan SK, Kalra S, Khanna A, et al. Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291, 413 patients[J]. Injury, 2009, 40(7): 692-697.
45. 　Tang X, Liu L, Yang TF, et al. Preliminary effect of proximal femoral nail antirotation on emergency treatment of senile patients with intertrochanteric fracture[J]. Chin J Traumatol, 2010, 13(4): 212-216.

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《華西醫學》

老年人股骨轉子間骨折國內外治療進展

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《華西醫學》

老年人股骨轉子間骨折國內外治療進展

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