股骨近端抗旋髓内钉治疗高龄股骨转子间骨折

Proximal Femoral Nail Antirotation for Intertrochanteric Fractures in Elderly Patients

目的 探讨股骨近端抗旋髓内钉（PFNA）对于高龄股骨转子间骨折患者的治疗价值。方法 85例高龄股骨转子间骨折患者，年龄78～93岁，平均82岁。根据Evans-Jensen股骨转子间骨折分型标准进行分型，Ⅰ型5例，Ⅱ型20例，Ⅲ型47例，Ⅳ型12例，V型1例，均为闭合性骨折。均采用PFNA微创治疗。结果 1例死亡，84例患者进行随访，时间3～12个月，平均10个月。术后随访，骨折均一期愈合，愈合时间8～16周，平均12周。均未见感染、骨不愈合、褥疮及深静脉栓塞等并发症发生。参照Harris髋关节功能评价标准：优63例，良15例，中5例，差1例，死亡1例，优良率为91.7%。结论 PFNA具有操作简单、固定牢固、微创、患者可早期活动、符合生物力学固定原则等优点，尤其适用于高龄骨质疏松的股骨转子间骨折的治疗。

Objective To investigate the value of proximal femoral nail antirotation （PFNA） in the treatment of intertrochanteric fractures in elderly patients. Methods Eighty-five elderly patients with closed intertrochanteric fractures （78-93 years of age, average 82 years old） were treated with PFNA. According to Evans-Jensen classification, there were 5 cases of type Ⅰ, 20 cases of type Ⅱ, 47 cases of type Ⅲ, 12 cases of type Ⅲ, and 1 case of type V. Results Among the 85 patients, 1 patient died, and 84 patients were followed up for an average of 10 months （range, 3 to 12 months）. All fractures healed by first intention. The mean healing time was 12 weeks （range, 8 to 16 weeks）. No patients had infection, nonunion, bedsores, deep vein thrombosis and other complications. According to the Harris hip score, results were excellent in 63 cases, good in 15, medium in 5, poor in 1,and death in 1. The excellent and good rate was 91.7%.Conclusion PFNA provides simple operation, firm fixation and minimal invasion, allows patients to exercise early, and meets biomechanical principles in the treatment of intertrochanteric fractures, especially in elderly patients with osteoporosis.