股骨近端防旋髓内钉治疗老年股骨转子间骨折的复位技巧

Reduction skills in treatment of geratic femoral intertrochanteric fractures with proximal femoral nail anti-rotation

目的探讨股骨近端防旋髓内钉（PFNA）治疗老年股骨转子间骨折的闭合复位技巧，并总结经验。方法2006年3月至2010年12月采用闭合复位PFNA治疗73例股骨转子间骨折患行，男26例，女47例；年龄63～97岁，平均80．6岁。骨折按AO分型：3lA2型64例，31A3型9例；按改良Evam分型：ⅡA型15例，ⅡB型16例，Ⅲ型42例。术前仔细阅读患者影像资料，通过牵引、内旋、后侧支撑歧撬拔等方法进行闭合复位，选择合适长度的PFNA进行内吲定。应用Fogagnolo复位标准评定骨折复值质世，采用髋关节Harris评分评估患髋功能。，结果55例（75．3％）患者术后获12～48个月（平均27．4个月）随访，l8例患者失访（包括9例死亡患者）。应用Fogagnolo复位标准评价骨折复他质艟：优43例，可12例.骨折愈合时间为8-16周，平均10周。患者术后平均8周（6～16周）可完令负醇行走。兀感染、深静脉血栓形成、髋内翻畸形、股骨头切割及断钉发生，其中2例因术后摔倒致主钉远端股骨干骨折，二期行加长PFNA内同定治疗。按髋关节HaMs评分标准评定患髋功能：优34例．良16例，中5例，优良率为90．9％。结论对于老年股骨转子间骨折，闭合复位时可以通过一定的复位技巧来纠正内翻移位、向后成角移位及旋转移位等情况，从而提高骨折复位质量，顺利地应用PFNA进行微创治疗、

Objective To discuss the reduction skills in the treatment of geratie femoral intertrochanterie fractures with proximal femoral nail anti-rotation （PFNA）. Methods From March 2006 to December 2010, 73 ohl patients with femoral intertrochanterie fractures were treated with PFNA. They were 26 males and 47 temales, with an average age of 80.6 years （ranged from 63 to 97 years）. According to the AO classification, there were 64 cases of type 31 A2 and 9 cases of 31A3. According to the modified Evans classification, there were 15 cases of type liA, 16 cases of ⅡB and 42 cases of type m. Close reduction was conducted through traction, internal rotation, posterior buttress and prying. Internal fixation was performed with appropriate PFNA. Adequacy of reduction was evaluated according to the criteria of Fogagnolo and hip flmction according to the HmTis score. Results Eighteen patients were lost to the follow-up, including 9 deaths. The other 55 patients （75.3%） were tollowed up for 27.4 months on average （ranging from 12 to 48 months） . Reduction was good in 43 cases and acceptable in 12 cases. The mean time of hone union was 10 weeks （ranging from 8 to 16 weeks）. The mean time for complete weight loading was 8 weeks （ranging from 6 to 16 weeks） . No wound infection, deep vein thrombosis, hip varus deformity, femoral head cutout, or nail breakage happened. Two distal femoral fl＇actures occurred due to postoperative fall and were treated with secondary internal fixation with extended PFNA. The hip function was excellent in 34 cases, good in 16 cases and moderate in 5 cases, with a good to excellent rate of 90. 9 %. Conclusion In the treatment of geratic femoral intertrochanteric fractures with PFNA, unsatisfactory reduction can be rectified through skills like traction, internal rotation, posterior buttress and prying.