股骨近端防旋髓内钉治疗各型股骨粗隆间骨折200例

Clinical results of proximal femoral nail antirotation treating 200 cases of intertochanteric fractures

目的股骨近端防旋髓内钉(PFNA)治疗国际骨科协会(AO)各型股骨粗隆间骨折患者的临床报道。方法回顾攀枝花学院附属医院骨科医院髋关节外科从2011年1月至2015年12月,共治疗股骨粗隆间骨折200例(此时间段病例全部随机纳入至200例,无排除病例),男性114例,女性86例,其中70岁以上患者达117例。根据AO分型:Ⅰ型63例,Ⅱ型99例,Ⅲ型38例,全部采用PFNAⅡ手术治疗。其中慢性心功能不全22例,慢性呼吸功能不全16例,慢性肾功能不全9例,慢性肝功能不全7例。结果平均手术时间(45±20)min,平均手术切口(5±2)cm,平均失血量(85±15)ml。术后伤口一期愈合199例,1例患者术后发生切口感染,在术后8周骨折部分愈合后取出内固定清创术后伤口愈合。200例患者骨折全部愈合,其中3例为骨折延迟愈合。术后在院生存率100%,术后半年的随访中有3例患者分别因呼衰和心衰死亡,生存率为98.5%。结论 PFNAⅡ手术治疗AO各型股骨粗隆间骨折,手术方法简单,手术创伤小,手术并发症少,符合尤其是高龄粗隆间骨折患者的治疗要求。

Objective To evaluate the clinical results from 200 cases in AO different types of intertrochanteric fractures treated by proximal femoral nail antirotation （PFNA） Ⅱ. Methods From January 2011 to 2016 December 200 cases of intertroehanteric fractures were treated, including 114 males and 86 females, among whom 117 patients were older than 70 years old. According to AO classification 63 cases were type Ⅰ , 99 cases were type Ⅱ , and 38 cases were type Ⅲ. Among these patients, 26 patients had chronic heart insufficiency, 19 patients had chronic pulmonary insufficiency, nine patients had chronic renal insufficiency, and seven patients had chronic hepatic insufficiency. All these patients were treated by PFNA Ⅱ. Results The average operation time was （45 ± 20）min, the average incision length was （5 ± 2） era, the average blood loss during the operation was （85 ± 15） ml. A total of 199 patients were healing by first intention. One patient developed incision infection after the operation, eight weeks after operation, the internal fixation was taken out by wound debridement, and the wound was healed two weeks later. Normal fracture healing was observed in all 200 patients, with only three cases of delayed fracture healing. No hospital mortality was observed ; three patients died of pulmonary insufficiency and heart disease in the six months follow - up. Survival rate in six months was 98.5%. Conclusion PFNA Ⅱ operation is an effective treatment for different types of femoral intertrochanteric fracture, which is less traumatic, less complications, especially good for aged patients.