闭合复位PFNA治疗老年不稳定型股骨粗隆间骨折疗效观察

Efficacy observation of PFNA closed reduction to treat elderly patients with unstable intertrochanteric fracture

目的：探讨闭合复位下防旋股骨近端髓内钉（ PFNA）治疗老年不稳定型股骨粗隆间骨折的疗效。方法对36例老年股骨粗隆间不稳定型骨折采用闭合复位PFNA固定，术后积极抗骨质疏松治疗，早期指导患者功能康复锻炼，出院后对患者骨折愈合情况及髋关节功能进行随访。结果36例患者均获得随访12～18个月，平均15个月，所有患者骨折均愈合，无髋内翻畸形病例，骨折愈合时间3～7个月，平均4．1个月，末次随访患者髋关节功能Harris评分优16例，良18例，可2例。结论闭合复位PFNA治疗老年不稳定型股骨粗隆间骨折具有创伤小，对骨折端血运破坏小，固定牢靠，防旋转及支撑能力强，促进患者早期康复等优点，是目前治疗老年不稳定型股骨粗隆间骨折行之有效的方法。

Objective To explore the efficacy of closed reduction and internal fixation using proximal femoral nail antirotation （ PFNA） to treat elderly patients with unstable intertrochanteric femoral fractures .Methods A total of 36 elderly patients with unstable intertrochanteric femoral fracture were subjected to closed reduction and internal fixation u -sing PFNA.After operation , active treatment was provided to prevent osteoporosis , while early guidance about rehabilita-tion exercise was given for better physiological function .All patients were followed up after discharge to assess their frac-ture healing and hip joint function .Results All patients were followed up for 12 to 18 months, with an average of 15 months.All fractures were healed , without coax varus deformity .The fracture healing time was 3 to 7 months, with an average of 4.1 months.In the last follow-up visits, 16 patients, 18 patients and 2 patients were assessed excellence , goodness and fairness in Harris function scores , respectively .Conclusion Closed reduction and internal fixation using PFNAs can be adopted to treat elderly patients with unstable intertrochanteric fractures , with small incision and little damage to fracture-end blood supply .The approach can provide strong fixation and supporting against rotation and pro-motes recovery at early stage , which can be widely applied in clinical practice .