微创短重建钉内固定治疗老年股骨转子间骨折

Minimally invasive Trochanteric Antegrade Nail fixation for the treatment of intertrochanteric fractures of femur in elder

目的:探讨微创短重建钉内固定对老年股骨转子间骨折的疗效。方法:自2005年1月至2008年6月,对80例股骨转子间骨折微创短重建钉内固定手术病例进行跟踪随访,评定疗效。男16例,女64例;年龄65～93岁,平均75岁;按照Evans分型Ⅰ型8例,Ⅱ型32例,Ⅲ型30例,Ⅳ型6例,Ⅴ型4例,均在C形臂X线机辅助下行微创短重建钉内固定术,术后1d开始被动功能锻练(CPM)和主动运动。结果:80例患者均得到随访,随访时间5～18个月,平均10个月,骨折全部愈合,骨折临床愈合时间10～14周,平均12周。无交锁螺钉豁出、断裂,3例近端螺钉向外退出约0.5cm,均无明显症状。3例患者出现下肢深静脉血栓形成(DVT),经治疗后下肢肿胀消退。根据Sanders髋关节创伤后功能评分,术后疼痛(9.08±1.19)分,行走(8.85±1.09)分,功能(9.10±1.27)分,运动肌肉力量(9.13±1.18)分,日常生活(8.91±1.07)分,X线评价(9.34±1.09)分。按评分优秀56例,良好20例,差4例。结论:微创短重建钉内固定创伤小、固定牢固、操作得当,是老年股骨转子间骨折理想的治疗方法。

Objective：To evaluate the clinical effect of minimally invasive Trochanteric Antegrade Nail （TAN） for the treatment of intertrochanteric fractures of femur in elder. Methods：From January 2005 to June 2008,80 patients with intertrochanteric fractures of femur were treated with minimally invasive fixation of Trochanteric Antegrade Nail. There were 16 males and 64 females with an average age of 75 years ranging from 65 to 93 years. According to Evans classification,there were 8 cases of typeⅠ,32 of typeⅡ,30 of typeⅢ,6 of typeⅣ and 4 of typeⅤ. After the operation of minimally invasive Trochanteric Antegrade Nail fixation,patients begun to do the continuous passive motion （CPM） and active motion of the injured hip joint and knee joint. Results：All patients were followed from 5 to 18 months with an average of 10 months. All factures were healing in time from 10 to 14 weeks with none screw breakage. Proximal screw exiting out about 0.5 cm occurred in 3 patients without obvert symptom. Three patients appeared lower limb deep venous thrombosis and were cured with medicine. According to the scales of Sanders,pain score was 9.08±1.19,ambulation score 8.85±1.09,function score 9.10±1.27,muscle strength score 9.13±1.18,daily life score 8.91±1.07,X ray evaluation score 9.34±1.09,so as the resilts were excellent in 56 cases,good in 20,poor in 4. Conclusion：With the advantage of mini invasion,operative convenience and stable fixation,minimally invasive TAN fixation is an effective method for intertrochanteric fractures in elder.