PFNA治疗Seinsheimer ⅡB-V型老年股骨转子下骨折

Proximal Fomaral Nail Antiritation for the Treatment of Seinsheimer ⅡB-V Femoral Subtrochanteric Fracture in the Olds

目的：判断防旋型股骨近端髓内钉（Proximal fomaral nail antiritation，PFNA）内固定治疗老年股骨转子下骨折的安全性和有效性。方法回顾性分析采用该方法治疗老年股骨转子下骨折23例。观察内容包括患者年龄、性别、骨折分型、手术时间、出血量、复位质量、骨折愈合时间以及并发症等。结果根据股骨转子下骨折的Seinsheimer分型标准，ⅡB型6例、ⅡC型4例、ⅢA型5例、ⅢB型3例、Ⅳ型3例、Ⅴ型2例。手术时间平均（60.3±19.3）min（43～101 min），术中出血量平均（210.6±88.2） ml（160～410 ml）。23例均获得随访，平均时间（12.4±2.8）个月（8～18个月）。骨折复位良好，内固定可靠。骨折愈合平均时间（4.5±1.7）个月（3～6个月）。术后X线片显示平均髋内翻＜（10.2°±2.5°）（5°～16°）。1例患者术后下肢长度偏差超过1 cm。髋关节功能Harris评分：优15例，良6例，可2例，优良率91.3%。结论 PFNA内固定治疗老年股骨转子下骨折，手术方法可行，术后并发症少。

Objective To investigate the curative effect of proximal femoral nail antirotation （PFNA） in the treatment of Seinsheimer IIB-V femoral subtrochanteric fracture in the olds.Methods We reviewed 23 patients with subtrochanteric fractures, which were stabilized with PFNA. The classiifcation,operating time, blood loss and any technical diffculty with the implant were recorded. Patients were followed clinically and radiologically for union at fracture site and implant related complications.Results As per the Seinsheimer classiifcation, there were 6 typeⅡB,4 typeⅡC,5 typeⅢA, 3 typeⅢB,3 typeⅣ and 2 typeⅤ cases. The mean operating time was （60.3±19.3） min（43-101 min）and total blood loss averaged （210.6±88.2） ml （160-410 ml）. 23 cases were followed up for （12.4±2.8） months （8-180 months）. All patients showed signs of union at an average of （4.5±1.7） months （3-6 months）, with minimum varus collapse〈（10.2°±2.5°） （5°-16°）,one limb shortening. There were 15 excellent cases, 6 good, and 2 fair in Harris score.ConclusionPFNA in treatment of Seinsheimer IIB-V femoral subtrochanteric fracture provides stable fixation with high union rate and fewer complications in the olds.