应用股骨近端防旋髓内钉治疗高龄股骨转子间骨折

Application of proximal femoral anti-rotation nail for the treatment of elderly femoral intertrochanteric fracture

目的探讨应用股骨近端防旋髓内钉(PFNA)治疗高龄股骨转子间骨折的时机和效果。方法 2011年9月至2013年3月我院收治36例高龄股骨转子间骨折患者,其中A1型6例,A2型16例,A3型14例。36例患者均应用PFNA微创手术治疗,术后进行系统的康复锻炼;同时治疗基础疾病、加强护理预防血栓。用Harris评分对患者后期髋关节功能进行评估。结果平均住院时间4周,伤口一期愈合良好30例,因合并内科疾病死亡4例,伤口感染2例、经治疗后痊愈。21例患者获随访,根据Harris评分分析髋关节功能康复良好,优12例、良6例,可3例,优良率为85%。结论高龄股骨转子间骨折应用PFNA手术治疗不易损伤骨折局部的血供,骨折愈合及髋关节后期功能恢复良好,是高龄股骨转子间骨折患者较为理想的治疗方法。

Objective To explore and analyze the timing and postoperative effect of proximal femoral nail anti-rotation（ PFNA） for the treatment of elderly femoral intertrochanteric fracture. Methods From September 2011 to March 2013,there were 36 elderly patients with femoral intertrochanteric fractures in our hospital,including 6 cases of type A1,16 cases of type A2,and 14 cases of type A3. All the 36 patients received PFNA and systematic rehabilitation exercise. Treat the underlying disease and strengthen the nursing to prevent thrombosis at the same time. Hip joint function was evaluated by the Harris score system. Results The average hospitalization of patients is 4 weeks. The wound healing was good in 30 cases and wound infection occured in 2 cases who recovered after subsequent treatment,and the other 4 patients died due to complicated internal medicine diseases. 21 cases of patients were followed up,and their hip joint function recovered well according to the Harris score system,including 12 cases of excellent,6 cases of good,and 3 cases of eligible,with an excellent and good rate of 85%. Conclusion The application of PFNA for the treatment of elderly femoral intertrochanteric fractures has the advantages of less damage to the local blood supply and better recovery of fracture healing and hip joint function,which is an ideal treatment for the elderly patients with femoral intertrochanteric fractures.