股骨近端髓内针治疗不稳定型股骨粗隆间骨折的临床疗效观察

Clinical observation on the therapeutic effect of unstable intertrochanteric fracture with PFNA

目的观察应用股骨近端髓内针(PFNA)治疗不稳定型股骨粗隆间粉碎骨折的治疗效果,为推广该固定方法总结临床经验。方法回顾性分析泸州市中医医院2010年12月至2012年1月采用PFNA内固定治疗不稳定型股骨粗隆间骨折病例39例的临床资料。39例中男12例,女27例,年龄40～86岁,平均65.8岁。致伤原因:摔伤28例,车祸伤5例,高处坠落伤6例。骨折分型按AO分型,A2型25例,A3型14例。结果 39例中36例患者得到随访,随访时间3～12个月,平均8个月。36例患者平均手术时间比传统手术缩短30min,下地时间缩短15d,切口愈合良好,无感染等并发症发生。骨折愈合良好,无畸形愈合、螺钉松动、骨折并发症等现象。髋关节功能恢复按Harris髋关节评分标准评定(满分100分),优(90～100分)24例,良(80～89分)12例,可(70～79分)0例,差(<70分)0例,优良率92.31%。结论 PFNA治疗股骨粗隆间骨折简化了手术操作,手术创伤小,手术时间短,下床活动早,骨折愈合快,防旋转、切割,并发症少等优点,是治疗不稳定型股骨粗隆间骨折的良好方法,值得临床推广应用。

Objective To investigate the therapeutic effect of unstable intertrochanteric fracture with PFNA. Methods From December 2010 to January 2012,39 patients with femoral unstable in＇tertrochanteric fracture were trealed by proximal femoral PFNA,including 12 males and 27 females, aged 40--86 years old （average 65.8 years old）, including tumbling for 28 cases, traffic accident for 5 cases, falling from height for 6 cases,including 25cases of type A2,14 cases of type A3 according to AO classification. The effect was investigated by retrospective analysis. Results 36 cases were followed up for 3--12 months,average 8 months. All wounds healed well,and no postopera- tive complication occurred. All fracture cases healed well without deformed healing, screw loosening, plate fracture etc. According to Harris Hip Score, the functional recovery of hip was as follows： Excellent（〉90） 24 cases, Good （80 -89） 12 cases, Fair（70--79） 0 cases and Poor（〈.70） 0 cases, and the excellent and good rate was 92.31%. Conclusion PFNA in the treatment of intertrochanteric fractures with simplify surgical operations, small surgical trauma, shorten operating time, bed activity earlier, quick fractures heal, rotate and cut-proof, fewer complications, and other advantages, could be used for the treatment of unstable intertrochanteric fracture of the femur.