PFNA治疗高龄股骨粗隆间不稳定型骨折

Treatment for femoral unstable intertrochanteric fracture of senile patients with proximal femoral nail antirotation

[目的]评价防旋型股骨近端髓内钉（PFNA）治疗老年股骨粗隆间骨折的疗效。[方法]2005年12月-2007年6月，采用PFNA治疗老年股骨粗隆间不稳定型骨折32例，男15例，女17例；年龄70～86岁，平均78．5岁。按Evans分型：Ⅲ19例，Ⅳ型11例，Ⅴ型2例，均为闭合性骨折。观察骨折愈合与功能恢复情况。[结果]手术时间45～70rain，平均52．4min。术中出血量为120～350mL，平均170mL。术后随访3～12个月，平均7．3个月。所有骨折均愈合，且大部分患者已完全负重行走（28例，占94％），愈合时间为10～18周，平均13．9周。按Sanders髋关节评分标准评定，优28例，良4例。[结论]PFNA操作简单，适合微创操作，创伤小、失血少、内固定可靠，是一种治疗老年股骨粗隆间骨折，特别是不稳定类型的，比较理想的内固定材料。

[ Objective] This work is to introduce the method for the treatment of femoral intertrochanteric unstable fracture of the senile patients with the proximal femoral nail antirotation （PFNA）. [ Methods] From December 2005 to June 2007, 32 consecutive patients with femoral intertrochanteric unstable fracture were treated with PFNA. There were 15 men and 17 women with average of 78.5 years old （range： 70 to 86）. According to Evans classification, 19 cases of the fracture were type Ⅲ, 11 were type Ⅳ and 2 were type Ⅴ. [Results] The mean operative time was 52.4 min （range： 45 to 70min）. The mean blood loss was 170 mL （ range ： 120 to 350）. The mean follow - up was 7.3 months （ range ： 3 to 12）. Fracture union occurred in all patients with a mean healing time of 13.9 weeks （range： 10 to 18）. No deformity of hip occurred. [ Conclusion] PFNA is more comfortable for human＇s biomeehanism and more favorable for the healing of the fracture as well as the recovery of the hip function. It has the advantage of simpler manipulation, fewer traumas, less bleeding, strong fixation, anti - rotation, less loss osclerotin. It is believed that PFNA is an ideal internal fixation material for intertrochanteric fracture of femur.