股骨近端髓内钉治疗高龄股骨粗隆间不稳定型骨折

Treatment of femoral unstable intertrochanteric fracture in senile patients with proximal femoral nail

目的观察股骨近端髓内钉(PFN)治疗老年股骨粗隆间骨折的临床疗效。方法回顾性分析我院自2005年10月～2008年12月采用PFN治疗的33例老年股骨粗隆间不稳定型骨折患者,其中男16例,女17例;年龄71～89岁,平均(77.5±5.5)岁。按Evans分型:Ⅲ型18例,Ⅳ型10例,V型5例,观察骨折愈合与功能恢复情况。结果手术时间60～80min,平均(68.7±5.2)min。术中出血量为160～350ml,平均(210±14.5)ml。术后随访12～15个月,平均(13.3±5.5)个月。所有骨折均愈合,愈合时间为16～40周,平均(23.9±3.5)周。按Sanders髋关节评分标准评定,优27例,良6例。结论 PFN操作简单,创伤小、失血少、内固定可靠,是一种治疗老年股骨粗隆间骨折,特别是不稳定类型的,比较理想的内固定方法 。

Objective To analyze the clinical effectiveness of the proximal femoral nail （PFN） in the treatment of femoral intertrochanteric unstable fracture in the senile patients. Methods From October 2005 to December 2008, 33 consecutive patients with femoral intertmchanteric unstable fracture were treated with PFN. There were 16 men and 17 women with average age of 75.5 years old （range： 71 to 89）. According to Evans classification, 18 cases of the fracture were fallen into type Ⅲ, 10 into type Ⅳ and 5 into type Ⅴ. Results The mean operative time was 68.7 min （range： 60 to 80 min）. The mean blood loss was 210 ml （range： 160 to 350）. The mean follow-up duration was 13.3 months （range： 12 to 15）. Fracture union occurred in all patients with a mean healing time of 23.9 weeks （range： 16 to 40）. No deformity of hip occurred. Sanders scale of the hip function： 27 patients were graded in excellent and 6 good. Conclusion PFN is more comfortable for human’s biomechanism and more favorable for the healing of fracture as well as the recovery of the hip function. It has the advantage of simpler manipulation, fewer traumas, less bleeding, strong fixation. It is believed that PFN is an ideal internal fixation material for intenrochanteric fracture of femur.