股骨近端防旋髓内钉微创治疗老年股骨粗隆间骨折47例临床疗效分析

Analysis of therapeutic efficacies on the second generation of proximal femoral nail anti-rotation in the treatment of 47 cases elederly patients intertrochanteric fracture of femur

目的评价应用亚洲型股骨近端防旋髓内钉（PFNAⅡ）微创治疗老年股骨粗隆间骨折临床疗效。方法我院2009年10月-2010年8月采用PFNAⅡ微创治疗老年转子间骨折共47例。手术采用牵引床闭合复位,C臂机动态透视,小切口安放置入PFNAⅡ内固定器械。结果平均手术时间为45 min[（30-75）min],平均术中透视次数为16.5次[（12-28）次],平均术中失血量为92.7 mL[（35-180）mL]。术后47例患者均得到随访,平均随访时间为12.6个月[（6-18）个月],全部患者均获得骨折一期愈合,平均愈合时间为11周[（8-15）周],全部患者无髋内翻畸形,无螺旋刀片切出股骨头及迟发型股骨干骨折。采用髋关节功能Harris评分,优良率为93.6%。结论亚洲型股骨近端防旋髓内钉（PFNAⅡ）的设计更符合我国人群股骨近端解剖结构,操作简便快捷,手术时间短,创伤小,术后愈合效果好,适合早期功能锻炼,是目前治疗老年股骨粗隆间骨折患者的理想内固定物。

Objective To analyze therapeutic efficacies treatment with the second generation of proximal femoral nail antirotation in elederly people with intertrochanteric fracture of femur.Methods 47 elederly patients with femoral intertrochanteric fracture were received the treatment of PFNA Ⅱ from October 2009 to August 2010.The operation were carried out on the traction table with C-arm photoing and minimally invasive fixed with PFNAⅡ.Results The mean operative time was 45 min [（30-75） min],the mean operative ridography was 16.5 times[（12-28） times],the mean operative blood loss was 92.7 mL [（35-180） mL].All 47 patients were followed up after operation,the mean duration of follow up was 12.6 months[（6-18） months],all patients obtained bone union range from 8 to 15 weeks（average 11 weeks）.There was no malformation of hip varus,no cut-out or tardive fracture of femur during the fllow-up period.According to the Harris hip scores,the excellent and good function recovery rate of the hip joints was 93.6 percent.Conclusion The design of PFNAⅡ is more suitable for Chinese population,miniinvasive and it is a good method for treatment of elderly patients with femoral intertrochanteric fracture.