摘要
随着全球人口的老龄化,髋部骨折患者的数量正在逐渐增加。据估计,到2025年将有260万人遭受髋部骨折,到2050年将达到700万到2100万人^([1])。手术是老年髋部骨折患者的主要治疗方法,保守治疗仅用于骨折前不能行走或不能耐受手术的患者。股骨粗隆间骨折常采用闭合复位内固定的手术方式,影响手术效果的因素包括骨骼强度、复位程度、内固定物的选择、术后疼痛和康复的管理等。术后常见并发症包括骨折不愈合、内植物切出、假体周围骨折、股骨头坏死等^([2])。当患者骨折愈合后出现髋部疼痛、步态异常等表现时需警惕相关并发症的发生。现将北京大学第一医院收治的1例股骨粗隆间骨折术后同侧股骨颈骨折病例报道如下。
Hip fractures are common in elderly patients and are associated with significant morbidity and mortality,often referred to as the“last fracture of life”.These fractures frequently result in a loss of functional independence.Evidence suggests that early surgical intervention can reduce mortality.The selection of treatment modality should take into account factors such as the type of fracture,the patient’s age,and overall health status.This case report discusses an 88-year-old female patient who sustained an unstable intertrochanteric fracture of the left femur following a fall.She underwent closed reduction and internal fixation using an InterTAN intramedullary nail,resulting in a satisfactory postoperative recovery.Sixteen months following the surgical procedure,the patient presented with progressive pain in the left hip and ambulatory difficulties,absent from any evident trauma.Radiographic analysis identified a fracture of the left femoral neck accompanied by some degree of acetabular bone degradation attributable to the implant.Subsequently,the patient underwent removal of the internal fixation device and received a hemiarthroplasty.The postoperative course was uneventful,with marked improvements in both pain levels and functional capacity.This case underscored the intricate nature of femoral neck fractures following the internal fixation of intertrochanteric fractures.Contributing factors may include advanced age,osteoporosis,and stress shielding induced by the implant.In patients presenting with hip pain or gait disturbances months to years post-intertrochanteric fracture surgery,the potential for a new fracture should be consi-dered,even in the absence of an explicit traumatic incident.Radiographic imaging is imperative to exclude the presence of a fracture,particularly in individuals with high-risk factors such as advanced age,osteoporosis,alcohol abuse,and a history of hormone therapy.Management of such cases may necessitate the removal of internal fixation devices and the implementation of hemiarthroplasty or total hip arthroplasty,contingent upon the patient’s surgical tolerance.Crucially,anti-osteoporosis therapy serves as a vital preventive strategy.Considering the high-risk profile of elderly patients with hip fractures,diligent follow-up and timely intervention are paramount to mitigating complications and mortality,thereby enhancing the quality of life for these patients.This case highlights the critical need for increased vigilance and comprehensive management of elderly patients with hip fractures to enhance treatment outcomes and improve prognosis.
作者
宁太国
潘利平
叶一林
曹永平
NING Taiguo;PAN Liping;YE Yilin;CAO Yongping(Department of Orthopaedics,Peking University First Hospital,Beijing 100034,China)
出处
《北京大学学报(医学版)》
北大核心
2025年第3期610-613,共4页
Journal of Peking University:Health Sciences
关键词
髋部骨折
粗隆间骨折
股骨颈骨折
Hip fracture
Intertrochanteric fracture
Femoral neck fracture
