PFNA治疗老龄不稳定股骨转子间骨折76例的临床疗效分析

Clinical effective analysis of treatment of unstable intertrochanteric fractures with PFNA in 76 elderly cases

目的评价采用股骨近端抗旋转髓内钉(PFNA)手术治疗老龄不稳定股骨转子间骨折的疗效和并发症。方法回顾性分析使用PFNA治疗不稳定股骨转子间骨折患者76例,跌倒致伤58例(76%),车祸伤18例(24%)。依内固定研究会(AO/ASIF)分型A2型骨折65例(86%),A3型11例(14%)。并对术中细节、复位质量、螺旋刀片位置、术后并发症和最终结果进行评价。结果 58例采用闭合复位内固定,18例行切开复位内固定。62例(82%)手术操作置入PFNA顺利,术后影像学评价骨折复位好61例(80%),可14例(18%),差1例(2%)。螺旋刀片位置57例(75%)位于股骨头中央,股骨头后下方11例(14%),后上方2例(3%),前上方6例(8%),术后平均颈干角为(128±4.8)°。66例(95%)患者在术后6个月内愈合,3例(5%)延迟愈合。59例(86%)患者恢复到受伤前活动水平。没有股骨颈切出和刀片进入髋臼病例发生。结论采用PFNA能够成功治疗不稳定股骨转子间骨折,螺旋刀片能够增加在骨质疏松骨骼的锚固力,防止股骨头切割和旋转及内翻。

Objective To evaluate the clinical results and the complications of treatment of unstable intertrochanteric fractures with PFNA in elderly patients.Methods 76 patients with unstable intertrochanteric femoral fractures were treated with a PFNA.21（28%） males and 42（72%） females with a mean age of（69.6±7.4）years（55-87years）.58（76%） fractures resulted from a fall injury and 18（24%） resulted from traffic accidents.65（86%） fractures belonged to AO/ASIF type A2 and 11（14%） cases belonged to A3.Primary objectives were assessment of surgical details,quality of reduction,position of helical blade,postoperative complications and final outcome measurements.Results 58 patients were operated by close reduction and 18 patients required open reduction.62（82%） operations were completed easily.Fracture reduction was good in 61（80%）,acceptable in 14（18%） and poor in one patients（2%）.The PFNA blade position was central in 57 patients（75%）,posterio-inferior in 11 patients（14%）,postero-superior in 2 patients（3%） and antero-superior in 6 patients（8%）.Mean post-operative neck-shaft angle was 128±4.8°.66 fractures（95%） healed within 6 months,3 patients（5%）had delayed union.59 patients（86%） regained the pre-trauma mobility within the follow-up period.No patient was found the PFNA blade cut out or penetrated into acetabulum.Conclusion Unstable intertrochanteric femoral fractures were treated successfully with the PFNA.The PFNA blade appears to provide additional anchoring and prevent cut out,rotation and varus of femoral head/neck fragment in osteoporotic bone.