股骨近端防旋髓内钉治疗股骨转子间骨折临床观察

Clinical observation of proximal femoral anti rotation nail for the treatment of femoral intertrochanteric fracture

目的:探讨PFNA治疗股骨转子间骨折疗效及对其隐性失血。方法:2012年1月至2015年1月采用PFNA治疗股骨转子间骨折患者49例,男41例,女8例;年龄65~91岁,平均79岁。骨折按改良Evens分型:Ⅰ型1例,Ⅱ型12例,Ⅲ型36例;均为新鲜骨折。患者患髋疼痛、活动受限,患髋肿胀、皮下瘀血,外旋畸形,X线及CT检查提示均为完全骨折。49例患者采用闭合复位PFNA内固定手术治疗,3例患者因骨折粉碎,闭合复位不满意,予以有限切开复位后PFNA固定。结果:患者手术切口均为甲级愈合,无感染及内固定失效等并发症发生。49例患者获得随访,时间6~36个月,平均22个月。VAS疼痛评分术前的7.70±1.97,术后6个月1.00±0.26,较术前明显好转(t=2.68,P<0.01)。髋关节Harris评分由术前的8.70±4.19提高至术后6个月91.70±5.31,其中优34例,良7例,可7例,差1例。患者骨折愈合时间8~16周,平均12周。1例患者由于骨质疏松,骨折粉碎严重,同时伴有精神分裂症,依从性差,故出现股骨大转子移位,经保守治疗获得愈合。结论:股骨转子间骨折是老年人常见创伤类型,在缓解疼痛、恢复髋关节功能、提高病患生活质量上,PFNA取得了令人满意的效果,但其存在的隐性失血值得关注。

Objective：To explore the curative effect and the recessive loss of blooding of PFNA for the treatment of intertrochanteric fractures of femur. Methods：From January 2012 to January 2015,a total of 49 patients with intertrochanteric fractures of femur were treated with proximal femoral anti rotation nail including 41 males and 8 females with an average age of79 years old ranging from 65 to 91 years old. According to the modified Evans type,1 case was typeⅠ,12 cases were typeⅡ,36 cases were type Ⅲ. All cases were fresh fractures. Patients had hip pain,movement limited,joint swelling,bruising,extorsion deformity,X ray and CT examination showed completely fractures. All patients were treated by closed reduction and PFNA internal fixation. Three comminuted fractures using closed reduction were not satisfied,then were treated by limited PFNA fixation after open reduction. Results：The patients＇ incision got the grade A healing,no complications such as infection and internal fixation failure happened. All patients were followed up from 6 to 36 months（means 22 months）. The pain VAS score decreased from preoperative 7.70±1.97 to 1.00±0.26 at 6 months after operation（P〈0.01）. Harris hip score improved from preoperative 8.70±4.19 to 91.70±5.31 at 6 months after operation（P〈0.01）. The outcome at 6 months after operation was excellent in 34 cases,good in 7,poor in 1. The fracture healing time was from 8 to 16 weeks with an average of 12 weeks after operation.One patient with osteoporosis,crushing broken,poor compliance,associated with schizophrenia at the same time,appeared with the displacement of the femoral greater trochanter,with conservative treatment for healing. Conclusion：Intertrochanteric fractures of femur are common in the elderly trauma,in pain relief,recovery of hip function,to provide quality of life for the patients,PFNA achieved satisfactory effect,but its existence is worth to pay close attention to the recessive loss of blood.