防旋股骨近端髓内钉治疗老年不稳定型股骨转子间骨折

Proximal femoral nail anti-rotation for unstable femoral intertrochanteric fractures in senile patients

目的探讨应用防旋股骨近端髓内钉（PFNA）治疗老年股骨转子间骨折的方法及疗效。方法2006年6月至2008年8月，收治41例老年股骨转子间骨折患者，Evans—Jensen分型：HA型11例，ⅡB型24例，Ⅲ型6例；其中男12例，女29例；平均年龄74．3岁（67～92岁）。均在C型臂x线机透视下闭合复位后采用PFNA内固定治疗，术后髋关节功能采用Harris评分。结果所有患者均获得随访，时间6～31个月，平均17．2个月。骨折均愈合，时间10～17周，平均12．5周。术后髋关节Harris评分：优26例，良13例，可2例，优良率为95．1％。均未出现感染、髋内翻畸形、下肢外旋及短缩畸形、螺旋刀片切割股骨头、股骨干骨折、内固定失效及延迟骨愈合等并发症。结论PFNA治疗老年不稳定型股骨转子间骨折符合生物学固定原则，对骨折端的血运影响和骨质破坏较小，具有操作简单、创伤小、内固定牢靠、可早期功能锻炼及术后并发症少等优点，疗效满意。

Objective To evaluate the clinical effects of proximal femoral nail anti-rotation （PFNA） in treating femoral intertroehanteric fractures in the aged patients. Methods Under the guidance of fluoroscopy, closed reduction, minimally invasive incision and percutaneous PFNA fixation were applied to treat 41 old patients with femoral intertrochanterie fracture from June 2006 to August 2008 in our hospital. They were 12 males and 29 females, with an average age of 74. 3 （67 to 92 years） years. According to Evans-Jensen classification, there were 11 cases of ⅡA, 24 ⅡB, and 6 Ⅲ. Postoperative hip functions were evaluated by Harris system. Results The patients were followed up for 17.2 （6 to 31 ） months averagely. Fracture union was achieved in all patients with a mean healing time of 12.5 （10 to 17） weeks. The postoperative Harris score was excellent in 26 cases, good in 13 and fair in 2. The total excellent to good rate was 95. 1%. No infection, coxa vara, external rotation or shortening deformity, cut-out, fracture of femoral shaft, internal fixation failure or bone nonunion occurred. Conclusion Since PFNA fixation has advantages of less interference with blood circulation at the fracture ends, little osseous destruction, simple operation, limited invasion, less blood loss, anti-rotation, stable fixation and few postoperative complications, it is an effective treatment for femoral intertrochanteric fractures in senile patients.