股骨近端带锁髓内钉联合抗骨质疏松药物治疗高龄不稳定型股骨粗隆间骨折的疗效观察

Effects of proximal femoral nail combining anti- osteoporotic drugs on elderly patients of unstable femoral intertrochanteric fractures

目的：采用股骨近端带锁髓内钉（ PFN）微创内固定术结合规范抗骨质疏松方案治疗高龄不稳定型股骨粗隆间骨折，评估近期疗效。方法2010年1月至2012年12月，对92例不稳定型股骨粗隆间骨折行微创内固定术治疗，其中男32例，女60例，年龄70～88岁，平均年龄78．5岁。骨折采用Tronzo-Evans分型，其中Ⅲ型46例，Ⅳ型34例，Ⅴ型12例。术前骨密度测量值（ DEXA法）为0.46～0.82 g/cm2，平均0.64±0.16 g/cm^2，均达到严重骨质疏松的诊断标准。固定方式采用股骨近端带锁髓内钉（ PFN），骨缺损严重者予Wright人工骨粒植入。术后早期床上进行双下肢肌肉锻炼，CPM机辅助治疗。先后给予鲑鱼降钙素、唑来膦酸并补充钙剂、维生素D进行抗骨质疏松治疗。结果所有患者均顺利完成手术，术后无伤口感染等并发症；根据Parker髋关节功能评分，优62例，良22例，一般6例，差2例，优良率91.3％。所有患者均获得12个月以上连续随访，经X线片证实均达到骨性愈合。骨折愈合时间12～18周，平均14.5周，3例患者发生旋转螺钉向后轻度退出。结论 PFN结合抗骨质疏松治疗高龄不稳定型股骨粗隆间骨折，具有创伤小、固定可靠，利于骨折愈合等优点，近期疗效满意。

Objective To observe the short -term effects of minimally invasive operations with proximal femoral nail （ PFN） combining the anti -osteoporotic drugs on the elderly patients with unstable femoral intertrochanteric fractures .Methods 92 patients （ 32 males and 60 females ） of femoral intertrochanteric fractures , whose average age was 78.5 years old （ range from 70 to 88 ） , received the minimally invasive operation of internal fixation with PFN from January 2010 to December 2012.According to classification criteria of Tronzo -Evans, there were 46 cases of type Ⅲ, 32 cases of type Ⅳ, and 12 cases of typeⅤ.The baseline of bone mineral density （ by DEXA） was 0.46~0.82 g/cm2 ,and the average value was 0.64 ±0.16 g/cm2 , which was diagnosed as severe osteoporosis .The severe damaged bone was filled with Wright artificial implants .Early rehabilitation training of hip , CPM-assisted therapy , and the standard anti -osteoporosis treatment which included the sequential medication of salmon calcitonin and zoledronic acid , together with calcium and Vitamin D , were recommended postoperatively .Results The patients were successfully operated without postoperative complications such as wound infection ect ..62＆amp;nbsp;cases were graded as excellent , 22 cases as good , six cases as fair and two cases as poor according to the hip-functional scoring method of Parker .The overall satisfaction rate was 91.3%.All the patients had been followed up for more than 12 months.The fracture healing had been demonstrated by X -rays 12 to 18 weeks （average 14.5w） after the operation.Slightly backward releasing of the rotary screws had been observed in three patients .Conclusion Because of the reliable fixation , minimal invasion and being conducive to healing , PFN with anti-osteoporosis therapy has been proved as a safe and effective method for treatment of the unstable femoral intertrochanteric fractures in the elderly patients with osteoporosis .