早期非全身麻醉股骨近端防旋髓内钉固定治疗90岁以上股骨转子间骨折

Treatment of femoral intertrochanteric fracture by early non general anesthesia and proximal femoral nail antirotation in patients over 90 years old

目的探讨早期非全身麻醉股骨近端防旋髓内钉（PFNA）固定治疗90岁以上股骨转子间骨折的临床疗效。方法回顾性分析2009年6月至2015年6月期间采用早期非全身麻醉PFNA内固定治疗的37例股骨转子间骨折患者资料，男14例，女23例；年龄为90．107岁，平均93岁；骨折AO分型：31-A1型11例，31—A2型14例，31。A3型12例。受伤至手术时间为8h至4d，平均3d。所有患者骨折均采用非全身麻醉闭合复位PFNA固定治疗。结果本组患者的手术时间为30-70min，平均40min；术中出血量为50～150mL，平均100mL。37例患者术后获平均12个月（6～16个月）随访。所有患者骨折均获愈合，愈合时间平均为12．5周（10—16周）。术后1例患者出现手术切口渗液。随访期间无一例患者发生下肢深静脉血栓形成、褥疮、泌尿系感染等卧床并发症，以及髋内翻畸形、内固定物松动、断裂、骨折延迟愈合等并发症。末次随访时根据髋关节Harris评分标准评定患髋功能：优11例，良19例，可6例，差1例，优良率为81．1％。结论早期非全身麻醉下PFNA固定治疗高龄股骨转子间骨折具有操作简单、创伤小、手术时间短、术中出血量少、能早期脱离卧床状态及并发症少等优点。

Objective To study the efficacy of early non general anesthesia and proximal femoral nail anti-rotation （PFNA） in the treatment of femoral intertrochanterie fracture in senile patients over 90 years old. Methods From June 2009 to June 2015, 37 senile patients with femoral intertrochanteric fracture were treated by early non general anesthesia and PFNA internal fixation. They were 14 men and 23 women, from 90 to 107 years of age （average, 93 years）. By the AO classification, 11 cases were type 31-A1, 14 ones type 31-A2, and 12 ones type 31-A3. The time from injury to surgery ranged from 8 hours to 4 days （average, 3 days）. All the patients underwent closed reduction and PFNA internal fixation in non general anesthesia. Results The operation time in this group ranged from 30 to 70 minutes （average, 40 minutes）. Their intraoperative bleeding ranged from 50 to 150 mL （average, 100 mL）. They were followed up for an average time of 12 months （range, from 6 to 16 months）. All the fractures healed after an average time of 12. 5 weeks （range, from 10 to 16 weeks）. Incision exudates occurred in one case postoperation. No postoperative complications such as deep vein throm- bosis of lower limb, bedsore, urological infection, hip varus deformity, implants loosening and breakage, and delayed union were observed during follow-ups. According to the Harris scores at the final follow-ups, the hip function was rated as excellent in 11 cases, good in 19, medium 6, and poor in one, yielding a good to excellent rate of fine rate of 81. 1%. Conclusions PFNA in early non general anesthesia is a successful treatment of femoralintertrochanteric fracture for eldedy patients. Advantages ofthe remedy include simple manipulation, limited trauma, shorter operation time, less bleeding, early ambulation, and reduced postoperative complications.