PFNA治疗老年股骨粗隆间骨折

Proximal Femoral Nail Antirotation in Treatment of Intertrochanteric Fractures in Old Aged

目的：评价股骨近端防旋髓内~Y（proximalfemoralnailantirotation，PFNA）治疗老年患者股骨粗隆间骨折的临床效果。方法：2009年3月～2011年6月，采用PFNA治疗老年股骨粗隆问骨折27例，按照Evans分型：工型2例，Ⅱ型4例，Ⅲ型16例，Ⅳ型5例，闭合复位，小切口置入PFNA。结果：手术时间40～70min．平均52．4min。术中出血量70～200ml，平均105．3ml。27例随访3～13个月，平均7．2月，骨折全部愈合，愈合时间11～16周，平均12周，未出现髋内翻，内固定物松动及切割现象。按Harris髋关节功能评分标准：优21例，良5例，中1例，优良率96．3％。结论：PFNA具有微创、操作简单、手术时间短、出血量少、固定牢靠、愈合率高等特点，尤其适用于老年骨质疏松患者，是治疗老年股骨粗隆间骨折较为理想的内固定材料。

Objective： To evaluate the therapeutic effect of intertrochanteric fractures treated with proximal femoral nail antirotation in elderly patients. Methofls：A total of 27 patients with intertrochanteric fractures were treated by PFNA in our hospital from March 2009 to June 2011. Based upon the Tronzo Evans classification, type I fractures were diagnosed in 9, cases, type ]] in 4 cases, type I~ in 16 cases, and type IV in 5 cases. The pa- tients received close reduction and minimal invagive operation. Results： The mean operation time in this series was 52.4 rain（40--70 min）, an the mean intraoperative blood loss was 105.3 m1（70--200 ml）. All the 27 pa- tients completed a follow up of 3 to 13months（average time 7.2 months）, during which all the fractures healed in 11 to 16 weeks with a mean of 12 weeks, without occurrence of vans deformity, hardware loosening or hardware cutting. According to the Harris Hip Score, 21 cases achieved excellent results, 5 were good, and 1 was fair, with a satisfactory rate at 96.3%. Conclusions： It is a reliable and ideal method to treat intertrochanteric fractures with PFNA in elderly patients, for the procedure is convenient and minimally invasive, resulting in firm fixation, less blood loss, short operation time, and high healing rate.