老年不稳定性股骨转子骨折髓内固定的治疗策略

Management of unstable trochanteric fractures with intramedullary fixation in elderly patients

目的探讨应用股骨近端髓内钉(proximal femoral nail,PFN)治疗老年不稳定性股骨转子骨折的手术方法及术后功能锻炼策略。方法采用PFN治疗老年不稳定性股骨转子骨折77例79侧,男29例29侧,女48例50侧。年龄60～95岁,平均73.6岁。根据AO/ASIF骨折分型:A2型56例58侧,A3型21例21侧。术后早期功能锻炼。对骨折复位情况、内固定效果、髋关节功能、术中及术后并发症等进行统计。结果术中复位效果优良率100%,手术操作优良率81%～84.5%。术后3～6个月时骨折均愈合。随访1～2年,髋关节功能恢复良好,无复位丢失、内固定失败等。结论PFN能提供可靠的内固定,用于老年不稳定性股骨转子骨折的治疗临床效果良好。

Objective To investigate the strategies of surgical management and postoperative rehabilitation related with the application of proximal femoral nail （ PFN ） on unstable trochanteric fractures in elderly patients. Methods A retrospective study was carried out with 79 cases of unstable trochantcrie fractures in elderly patients recruited. All the cases were treated surgically with PFN followed by early postoperative rehabilitations. The outcomes including the results of reduction, the hip function, and the rate of implant failure, etc were assessed. Results Good or excellent reduction was achieved in all the cases. The convenience of the surgery was graded 81% -84. 5%. All the fractures healed by 3 to 6 months post - operatively, and Harris hip score gained 63.5 after one year of follow - up without lost of reduction or implant failure. Conclusion PFN can provide sufficient biomechanical stability for unstable trochanteric fractures in elderly patients and lead to good clinical outcome.