Clinical Diagnosis And Treatment Of Osteoporotic Hip Fracture

objective: to study the choice of the clinical treatment of hip fractures in older adults andthe matters needing attention.methods: from January2010to January2012in our collection (yanan university hospital)hip fracture (femoral neck fracture and intertrochanteric fractures),150cases of patients withselection criteria: aged over60elderly patients with hip simple closed fractures, at the sametime give fight osteoporosis in patients with osteoporosis drug treatment, eliminatepathological fracture. Follow-up of138cases, among which65were male,female73cases male with an average age of69.3years, women mean age,71.4years;Causes: falling, traffic accident in16cases,122cases of combined internal medicine disease,110cases,25cases with hypertension,21cases of coronary heart disease, diabetes,29cases,16cases of chronic bronchitis with emphysema, merge these two or three kind of diseasepatients (19cases). Among them,55cases of intertrochanteric fracture,30cases of patientswith femoral trochanter fracture men, women,25cases, by Even cent type: type I4cases,12cases type II, III type21cases, Ⅳ11cases, Ⅴ type7cases. Among them with proximalfemoral interlocking intramedullary nail (PFN),32cases were fixed, fixed with dynamic hipscrew (DHS),23cases;35cases,83cases of femoral neck fracture, men, women,48cases,according to the Garden type points:6cases of type I and type II28cases,31cases III, typeⅣ18cases, internal fixation with58cases, including32cases of closed reduction and internalfixation and open reduction and internal fixation of26cases,25cases of artificial jointreplacement, postoperative follow-up:12-24months.Results: follow-up of138cases,12months to24months follow-up time,55cases ofintertrochanteric fractures in patients with51cases healed, the healing rate was92.7%;Proximal femoral interlocking intramedullary nail (PFN)31cases,29cases were healed, thehealing rate was93.5%; Fixed with dynamic hip screw (DHS)24cases,22cases were healed,the healing rate of91.7.%; Functional recovery with reference to the hip joint functionevaluation optimal22cases,28cases, and poor in5cases, fine rate was90.9%, including1case of wound infection after operation, as the superficial infection, after dressing the healing;Internal fixation loosening and slip in2cases, time for3-6months after surgery. In patientswith femoral neck fracture,83cases of hip replacement in the25cases,58cases, internal fixation and internal fixation in54cases healed, the healing rate of94.0%; Closed reductionand internal fixation of the32cases,30cases were healed, the healing rate was93.6%,2cases of femoral neck, shortening time of postoperative1-3months; Open reduction andinternal fixation of26cases,24cases healed, the healing rate was92.3%; Necrosis femoralhead necrosis in6cases, time to8to18months after operation,1case of patients withoutobvious clinical symptoms; Total necrosis rate was10.3%, among them GardenIII type was9.7%(3/39), GardenIV type was40.0%(2/5); Functional recovery with reference to the hipjoint function evaluation optimal34cases,40cases,9cases, fine rate was89.2%.conclusion:(1) analysis the elderly hip fracture treatment method choice: the elderlymerger other internal medicine diseases, conservative treatment mortality after hip fracture ishigher, in the absence of contraindications, to strive for the early surgical treatment. Hipfracture is divided into femoral neck fracture and intertrochanteric fracture. Intertrochantericfracture internal fixation choice, for stable fractures, two PFN and DHS internal fixationapparatus can be used, DHS price cheap, doctors can be in look, operation is relatively simple,for unstable fractures, the proximal femoral intramedullary nail with a lock (PFN) in thebiomechanical advantage, small surgical trauma, early functional exercise can, proximalfemoral locking intramedullary nail (PFN) can be used as a priority. Femoral neck treatmentchoice for Garden Ⅰ type (not complete fracture) and Ⅱ type (completely undisplacedfractures), in the absence of contraindications to surgery cases, early in the perspective guidingclosed reduction and cannulated screw fixation. For Garden type Ⅲ (tubes), easy to resetfractures, the early line of closed reduction and internal fixation with hollow nail treatment, butshould pay attention to the shortening of the femoral neck; Hard reset femoral neck fracture,such cases are often advocate open reduction and fixation, no surgical operation, could furtherdamage to the blood supply of femoral head for Ⅳ type (completely displaced fractures) and80elderly patients aged to artificial joints, bone healing, and dated sex fracture are bothapplicable artificial joints.(2) treatment of hip fractures in older adults, and treatment of osteoporosis and promotingfracture healing, prevent the occurrence of complications.