PFNA治疗高龄骨质疏松性股骨粗隆间骨折体会

Treatment of senile osteoporotic femoral intertrochanteric fracture with proximal femoral nail anti-rotation

目的探讨股骨近端抗旋髓内钉(proximal fermoral nail anti-rotation,PFNA)在治疗高龄骨质疏松性股骨粗隆间骨折临床疗效。方法应用PFNA治疗36例75岁以上高龄骨质疏松性股骨粗隆间骨折患者,手术采用闭合复位,小切口置入PFNA内固定,同时注重围手术期处理及抗骨质疏松治疗。结果 36例获得随访,时间9～24个月,平均12个月。其中1例90岁患者,于术后9个月死于脑梗塞,其余35例骨折全部愈合,无感染、骨不连、髋内翻、内固定失效等并发症的发生。根据Harris功能评分标准:28例优,4例良,3例中,优良率91.4%。结论 PFNA对于高龄骨质疏松性股骨粗隆间骨折具有微创性,固定可靠,疗效满意等优点。

Objective To evaluate the clinical effects in the treatment of senile osteoporotic femoral intertrochanteric fracture with proximal femoral nail anti-rotation（PFNA）.Methods Thirty-six cases over 75 years old with senile osteoporotic intertrochanteric fractures were treated with PFNA.All cases underwent closed reduction.The PFNA was implanted through a mini-incision without exposure of the fracture section during the operation,while focusing on perioperative management and treatment for osteoporosis.Results Thirty-six cases were followed up from 9 to 24 months（mean 12 months）.One case of 90 years old patient died of cerebral infarction after 9 months,and the remaining 35 fractures healed without infection,nonunion,varus,fixation failure and other complications occurred.According to Harris criterion,the function of hip joint was excellent in 28 cases,good in 4 cases,and fair in 3 cases,with the excellent and good rate being 91.4%.Conclusion PFNA can provide a good fixation and a minimal invasion for the senile patients with osteoporotic femoral intertrochanteric fractures and provide good clinical outcome.