股骨近端防旋髓内钉急诊治疗高龄股骨转子间骨折

Emergency treatment of intertrochanteric fractures with PFNA in elderly patients

目的探讨股骨近端防旋髓内钉(PFNA)急诊治疗高龄股骨转子间骨折患者的临床疗效。方法对29例80岁以上股骨转子间骨折患者在伤后24 h内急诊行PFNA固定治疗。结果术中失血量45～120(82±39)ml,手术时间35～76(53±19)min。1例术中发生医源性股骨干近段骨折,改用加长型PFNA固定。输血治疗26例,输血量150～330(247±71)ml。术后发生谵妄7例,深静脉血栓1例,上消化道出血1例。患者均获随访,时间4～36个月。骨折愈合时间12.9～25(15.6±6.4)周。疗效采用Sanders评分:优23例,良4例,差2例。结论 PFNA急诊治疗高龄股骨转子间骨折患者安全有效。

Objective To explore the emergency therapeutic effect of intertrochanteric fractures treated with proximal femoral nail antirotation （PFNA） in elderly patients. Methods 29 cases of intertrochanteric fractures over 80 years old were treated with PFNA mini-invasively in 24 hours after injury. Results The quantity of blood loss was 45 120 （82 -± 39）ml, and the time of operation was 35 -76 （53 ± 19 ）min. Iatrogenic fracture of femoral shaft occurred in 1 woman and long PFNA were applied. 26 patients were treated with blood transfusion of 150 - 330 （247 ± 71 ） ml. postoperative delirium occurred in 7 patients. Postoperative deep vein thrombosis and upper refractory gastrointes- tinal bleeding were observed respectively in 1 patient. All cases were followed up for 4 - 36 months. 29 fractures were healed uneventfully after 12. 9 -25 （15.6 ± 6. 4） weeks. According to Sanders criteria, the clinical results were ex- cellent in 23 cases, good in 4, and poor in 2. Conclusions The emergency treatment with PFNA is an effective method for intertrochanterie fractures in elderly Patients.