股骨近端抗旋髓内钉在高龄骨质疏松性股骨转子间骨折中的应用

Proximal femoral nail antirotation for osteoporotic intertrochanteric fractures in the elderly patients

目的探讨股骨近端抗旋髓内钉(PFNA)在治疗高龄骨质疏松性股骨转子间骨折中的临床疗效。方法25例高龄骨质疏松性股骨转子间骨折患者均经牵引、闭合复位,术中不显露骨折区域,小切口置入PFNA内固定治疗。结果23例获得随访,时间13～24个月,其中1例94岁患者因尿毒症术后1年死亡。余22例X线片显示骨折均一期愈合,愈合时间为(8.2±3)个月。无感染、骨不连、内固定失效、螺旋刀片滑脱、再骨折及髋内翻等并发症发生。根据Harris功能评分评定疗效:优18例,良2例。结论PFNA治疗高龄骨质疏松性股骨转子间骨折的初期疗效满意,内固定可靠,允许早期功能锻炼。

Objective To report the clinic outcome of surgical treatment with proximal femoral nail antirotation （PFNA） in elderly osteoporotic intertrochanteric fractures. Methods 25 case with elderly osteoporotic comminuted intertrochanteric fractures were treated with PFNA fixation. 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.Results 23 cases were followed up for 1324 months. 1 case of 94 years old died of uremia. 22 fractures healed primarily shown by X-ray picture checking and the average healing time was （8.2±3） months.No infection,nonunion,fixation failure,displacement,refracture or varus was found.According to Harris evaluation system,the results were excellent 18 cases,and good in 2.Conclusions PFNA can provide a good fixation for unstable osteoporotic intertrochanteric fractures in the elderly patients,which allows patients to do exercise early,and provides good clinical outcome.