亚洲型股骨近端防旋髓内钉治疗老年股骨转子间骨折体会

Initial experience of using proximal femoral nail antirotationⅡ to treat intertrochanteric femoral fractures in elderly patients

目的评价亚洲型股骨近端防旋髓内钉(PFNA-Ⅱ)治疗老年股骨转子间骨折手术策略及临床疗效,总结相关的经验体会。方法 2009年5月～2010年4月,我院共收治并行PFNA-Ⅱ固定的老年股骨转子间骨折21例,所有患者均于入院后72h内在全麻下完成手术;手术在骨科牵引床上进行,患者取平卧位,C型臂X线机透视下,患髋内收内旋屈曲30°牵引,骨折解剖复位后,自转子尖打入合适规格的PFNA-Ⅱ固定。统计手术时间和出血量,术后常规预防感染及预防深静脉血栓(DVT)治疗,并对内科疾病进行对症治疗,合并骨质疏松患者行抗骨质疏松治疗。结果本组21例均顺利完成手术,术中透视及术后髋关节正侧位X线片显示骨折复位固定好。手术时间28～51min,平均35min;出血量30～110ml,平均50ml;愈合时间平均9周。根据Harris功能评分:优18例,良2例,可1例;优良率95.2%。结论 PFNA-Ⅱ是PF-NA的亚洲型,更适合国人股骨近端的解剖特点,在手术操作、固定的稳定性方面优于PFNA-Ⅰ型。

Objective To evaluate the surgical strategy and clinical effect of proximal femoral nail antirotation II （PFNA-II） to treat elderly patients with intertrochanterie femoral fractures and sum up the relevant experience. Methods From May 2009 to Apr. 2010,21 elderly patients with intertrochanteric femoral fractures were fixed with PFNA under general anesthesia within 72 h after admission. Surgery was performed in the orthopedic traction bed in supine position. Hip was placed in 30° of flexion, and then the adduction and internal rotation of hips was applied under C-arm fluoroscopy. Then patients were fixed with the suitable PFNA II following achieving anatomical reduction. The operative time and blood loss were assessed. Conventional treatment was performed to prevent infection and deep vein thrombosis, and anti-osteoporosis treatment was applied for osteoporosis. Results This group of 21 patients were operated suceessfully,intraoperative fluoroscopy and postoperative lateral hip joint X ray showed a good reduction and fixation. The operation time was 28-51 rain,with an average of 35 min. The blood loss was 30-10ml ,with an average of 50ml. The average healing time was 9 weeks. Harris score indicated score of 84-96 ,averaging 90.8. Conclusion PFNA H is the Asian type of PFNA, which is more suitable for Asian patients＇ anatomical characteristics of the proximal femur. And it is better than PFNA- I in the aspects of surgical operation or the stability of fixation.