闭合复位股骨近端防旋髓内钉治疗老年股骨转子间骨折的疗效

Effect of close reduction and proximal femoral nail anti-rotation to treat intertrochanteric fractures in elderly patients

目的：探讨采用闭合复位股骨近端防旋髓内钉（PFNA）治疗老年股骨转子间骨折的临床疗效。方法对79例老年股骨转子间骨折患者采用闭合复位PFNA内固定，对患者的手术时间、术中出血量、输血量、术后引流量、骨折愈合时间、手术相关并发症等进行分析。按Harris评分标准对髋关节评分。结果手术时间39～88（51±14）min；术中出血量50～240（88±25）ml，其中31例术后输注浓缩红细胞1～4 U；术后引流量40～460（180±55）ml。1例术后27 d死亡，78例获得随访，时间12～25个月。患者骨折全部愈合，愈合时间13～22.4（16.5±3.2）周。出现褥疮1例，深静脉血栓1例，髋内翻畸形2例，发生头钉刺入髋臼1例，术后1年髋关节功能Harris评分：优69例，良6例，可3例，优良率为96.15％。结论闭合复位PFNA内固定治疗老年股骨转子间骨折创伤较小，操作简便，固定牢靠，安全有效。

Objective To explore the clinical effect of close reduction and proximal femoral nail anti-rotation （PF-NA）in the treatment of femoral intertrochanteric fractures.Methods 79 patients with femoral intertrochanteric frac-tures were treated by closed reduction and PFNA.Operative time,intraoperative blood loss,volume of blood transfu-sion,postoperative drainage,clinical healing time and operative related complications were analyzed.The criteria of Harris Score on hip function was evaluated.Results Operative time ranged 39-88 min with an average time of 51 ±14 min,and the intraoperative blood loss ranged 50-240 ml with an average volume of 88 ±25 ml.31 patients were treated with blood transfusion of red blood cells in a range of 1-4U.The volume of postoperative drainage ranged 40-460 ml with an average volume of 180 ±55 ml.One patient died at 27 d postoperation and 78 patients were followed up for 12-25 months.All fractures were healed uneventfully after 13-22.4 weeks with an average time of 16.5 ±3.2 weeks.One patient suffered with bedsore and another one with postoperative deep vein thrombo-sis.Hip varus deformity in 2 cases,1 case happened with nail pierced acetabulum.After 1 year,according to the cri-teria of Harris,the results were excellent in 69 cases,good in 6 and fair in 3,and the excellent and good rate was 96.15%.Conclusions The method of close reduction and PFNA in the treatment of femoral intertrochanteric frac-tures in elderly patients is minimal invasive,easy and simple to handle,fixation reliable,and the clinical effects are satisfactory.