股骨近端防旋髓内钉治疗老年股骨转子间骨折

Treatment of Femoral Intertrochanteric Fractures in the Aged with Proximal Femoral Nail Anti-rotation

目的评价股骨近端防旋髓内钉治疗老年股骨转子间骨折的方法和初步疗效。方法2006年1月至2007年10月,共对63例老年病人(男26例,女37例,平均76.3岁)采用闭合手法牵引复位,股骨近端防旋髓内钉治疗股骨转子间骨折,骨折采用Evans-Jensen分型,术后定期随访,根据Harris评分系统进行归档。结果63例老年病人,59例病人获得了6～29个月(平均12.6个月)的随访,手术时间35～80 min,平均54 min。术中出血量为100～300mL,平均140 mL。骨折全部愈合,愈合时间10～17周(平均13.2周)。按Harris评分进行评价,优28例,良23例,可6例,差2例,优良率86.4%。结论股骨近端防旋髓内钉治疗老年股骨转子间骨折,手术创伤小,并发症少,更加符合人体生物力学特征,是一种治疗老年股骨转子间骨折非常有效的方法。

Objective To evaluate the primary result and method of proximal femoral nail anti-rotation（PFNAR）,to treat intertrochanteric fractures in the elders.Methods Between Jurnary 2006 and October 2007,63 cases were treated with PFNAR by manipulative traction and closed reduction,there were 26 men and 37 women with a mean age of 76.3 years,which of them was classified to Evans-Jensen classification,all of cases were followed-up regularly and placed on files according to Harris scores.Results 59 cases of 63 old patients were followed up from 6 to 29 months（average 12.6 months） ,the operation time was 54 min（35-80 min）. The blood loss was 140 mL（100- 300 mL）. Union occurred in all patients with a healing time of 13.2 weeks （10-17 weeks ）. According to Harris score, 28 cases obtained excellent result ,23 good result, 6 fair result ,and difference in 2 ,and t＇he excellent and good rate was 86.4%. Conclusion PFNAR is a very good method to treat intertrochanteric fractures in the aged,and there are some advantages of small trauma,less complication,especially according to the function of vitodynamics of the bones.