微创股骨近端防旋髓内钉治疗老年股骨转子间骨折

Minimally Invasive Fixation with PFNA for Femoral Intertrochanteric Fractures in Elderly Patients

目的探讨微创股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)内固定术治疗老年股骨转子间骨折的方法和疗效。方法2005年12月至2007年3月,在术中C臂X线机透视下,采用闭合复位,股骨近端防旋髓内钉内固定术治疗股骨转子间骨折58例,其中顺转子间型30例,反转子间型12例,转子下型16例。按AO分型,A1型5例,A2型34例,A3型19例,均为闭合性骨折。男26例,女32例;年龄65～91岁,平均79.2岁。其中8例合并一种内科疾病,25例合并两种以上内科疾病。所有患者均经牵引、闭合复位,术中不显露骨折区域,小切口置入PF-NA。术后每月进行一次随访,根据随访时髋关节疼痛、功能及关节活动度进行Harris评分,作出疗效评定。结果平均手术时间是57min。术中平均出血量是168mL。平均手术切口长度是5cm。术后无感染、脂肪栓塞、深静脉血栓形成、骨折不愈合、髋内翻及旋转畸形等并发症发生,无死亡病例。58例患者全部获得12～15个月(平均13个月)的随访,骨折全部愈合,愈合时间8～12周,平均10周。Harris评分,优46例,良12例,优良率100%。结论微创PFNA内固定术治疗老年股骨转子间骨折具有手术创伤小、疗效较好、内固定可靠、允许早期功能锻炼、并发症少、促进患肢功能恢复的优点,更适合于治疗老年人股骨转子间骨折。

Objective To investigate the effects of treating femoral intertrochanteric fractures in elderly patients with minimally invasive fixation with proximal femoral nail anti-rotation（PFNA）. Methods From December 2005 to March 2007,58 cases with comminuted intertrochanteric fractures in the elderly patients were treated with closed manipulative reduction and minimally invasive fixation with PFNA. Surgery was done under the assistence of the C-arm image intensifier. There were 30 cases of syntrochanteric type, 12 cases of countertrochanteric type,and 16 cases of subtrochanteric type. According to AO classificstion, 5 cases were of A1 type, 34 cases of A2 type ,and 19 cases of A3 type. All of them were closed fractures. This study involved 26 males and 32 females,with an average age of 79.2 years （range, 65-91 years）. Eight cases were combined with one internal disease ,and 25 with more than two internal diseases. All cases were reduced through longitudinal traction on the traction table. The PFNA was implanted through a mini-incision without exposure of the fracture section during the operation. The patients were followed up once every month. The treatment effects were accessed according to Harris score system in terms of severity of pain ,range of motion and function of the joint. Results The mean operation time was 57 minutes （range,45 to 77 minutes）. The mean intraoperative blood toss was 168 mL （range, 120 to 200 mL）. The mean length of incision was 5 cm （range,4 to 6.5 cm）. All the 58 patients were followed up for an average of 13 months （range, 12 to 15 months）. None of them had such complications as infection, fat embolism,thrombus of deep vein,nonuNion of the fraeture,adduetion of coax,or convolute abnormity. And no one died. All of them recovered in 8 to 12 weeks ,with an average of 10 weeks. The Hareris score was excellent in 46 patients and good in 12. The good to excellence rates were 100%. Conclusion Femoral intertrochanteric fractures in elderly patients can be treated with minimally invasive fixation with PFNA which renders advantages of less operative trauma,providng more reliable fixation,allowing patients to do exercise early,achieving an excellent clinical outcome,reducing Complications and promoting functional recovery. PFNA internal fixation is more suitable for femoral intertrochanterie fractures of the elderly patients.