开放性骨质疏松性股骨远端骨折的治疗和伤害控制论的应用

目的 总结治疗开放性骨质疏松性股骨远端骨折的治疗和应用伤害控制观念的体会。方法 回顾性分析2002年1月～2003年12月60岁以上股骨远端开放性骨折住院治疗的病例21例。应用伤害控制学的原则：全面评价其外伤程度，条件允许则急诊手术，危重患者就临时固定，监护患者的生理指标，限期施行骨折固定手术。结果 17例患者获得超过4个月以上的随访，平均随访7．3个月。17例患者在术后平均15周内(79～168d)达到临床愈合。参照Shelbourne疗效评定标准，膝关节功能优良率达到78％。结论 治疗开放性股骨远端骨质疏松性骨折需要应用伤害控制的观念，兼顾患者全面情况，同时治疗骨质疏松和其它并存疾病。手术固定以股骨髁上逆行交锁髓内钉为主，早期功能锻炼。

Damage control in treatment of open osteoporotic fractures at distal femur in old patients

Objective To sum up the application of damage control theory in treatment of open osteoporotic fractures at distal femur. Methods A retrospective study was done to analyze 21 patients of over 60 years old who were hospitalized for open osteoporotic fractures at distal femur from Jan. 2002 to Dec. 2003. Under the guidance of damage control theory, we first assessed the general condition of the patient, then provided emergency operation when it was possible, and provided temporarily fixation (TF) and monitoring of physiological indexes for the patient with unstable vital signs. Afterwards the definite fixation and grafting were applied when it was possible. Results 17 patients were followed up for more than 4 months (averaging 7.3 months). 17 fractures united primarily at a mean of 15 weeks after operation (79 to 168 days). The excellent and good rate of knee function recovery was 78?cording to the criteria of Shelbourne. Conclusions The theory of damage control should be used to evaluate the general condition of the patients in treatment of open osteoporotic fractures at the distal femur in old patients. It is necessary to treat the fracture, osteoporosis and companion diseases simultaneously. Supracondylar retrograde intra medullary nails are usually used for fixation in the operation and early functional exercises of the knee should be encouraged.