PFNA-Ⅱ治疗老年股骨转子间骨折的临床疗效

Clinical outcomes of PFNA-Ⅱ for elderly patients with intertrochanteric fractures

目的分析亚洲型股骨近端防旋髓内钉(PFNA-Ⅱ)治疗老年股骨转子间骨折的临床疗效。方法回顾性分析2012年5月-2015年5月,因股骨转子间骨折且年龄>60岁,行PFNA-Ⅱ治疗的患者临床资料,共获得资料完整者35例。其中男性14例,女性21例;年龄65~84岁,平均70.2岁。骨折按EvansJensen分型:l型8例,Ⅳ型19例,Ⅴ型8例。评估手术时间、术中出血量、住院天数、下地行走时间、去拐时间、骨折愈合时间、并发症和Harris评分。结果随访时间12~46个月,平均29.2个月。手术时间为60~80min,平均69.5min;术中出血量为90~150mL,平均126.2mL;住院天数为7~13d,平均9.8d;下地时间为4~9周,平均6.2周;去拐时间为5~11周,平均7.3周;骨折愈合时间为10~16周,平均11.3周;至末次随访无一例患者出现切口感染、内固定失败、髋内翻、内固定松动、再骨折等;根据Harris评分,优15例、良17例、可3例,优良率91.4%。结论 PFNA-Ⅱ治疗老年股骨转子间骨折临床疗效满意,具有创伤小、再手术率低等优点。

Objective To analyze the clinical outcomes of Asian proximal femoral nail antirotation （ PFNA- Ⅱ ） for intertroehanteric fracture in elderly patients. Methods A total of 35 patients from May 2012 to May 2015 were retrospectively reviewed, including 8 cases of type III, 19 cases of type IV and 8 cases of type V, according to Evans - Jensen standard. The data was recorded, including the operative time, blood loss, length of hospital stay, walking time, time of walking without crutch, bone healing time, complications, and Harris score. Results The mean time of follow - up was 29.2 months. The mean operative time, blood loss, length of hospital stay, walking time, time of walking without crutch, and bone healing time was 60 - 80 （ 69.5 ） min, 90 - 150 （ 126.2 ） mL, 7 - 13 （ 9.8 ） d, 4 - 9 （ 6.2 ） weeks, 5 - 11 （ 7.3 ） weeks, and 10 - 16 （ 11.3 ） weeks, respectively. At the final follow - up, there was no wound infection, fixation failure or loosening, varus hip, or re-fracture. There were excellent out- comes in 15 patients, good in 17 patients, and fair in 3 patients, and the rate of good to excellent was 91.4%. Conclusion PFNA 11 in elderly patients can achieve good to excellent outcomes for treatment of the intertrochanter- ic fractures, and has the advantages of less injury and low re-operation rate.