PFNA在高龄股骨粗隆间骨折中的应用体会

Application experience of PFNA in senile patients with intertrochanteric fracture

目的探讨股骨近端防旋髓内钉(PFNA)在高龄股骨粗隆间骨折治疗中的应用和临床疗效。方法 45例高龄股骨粗隆间骨折患者均在C型臂透视下牵引闭合复位,应用PFNA微创治疗,观察治疗效果。结果本次手术时间为45~90 min,平均手术时间为60 min;术中出血量为100~150 ml,平均术中出血量为120 ml。45例患者全部获得随访,随访时间6~36个月,平均随访17个月。1例出院后突发心肌梗死死亡,1例行走后不慎跌倒导致髓内钉远端再骨折。其余均获得骨折愈合,且未发现螺旋刀片切割、退出,髋内翻畸形及术后感染等并发症。髋关节功能采用Harris评分中优31例,良9例,可5例,差0例,优良率为88.9%。结论 PFNA微创治疗高龄股骨粗隆间骨折疗效确切,损伤小,固定可靠,是治疗高龄股骨粗隆间骨折的较理想的方法。

Objective To investigate the application and clinical efficacy of proximal femoral nail antirotation（PFNA） in the treatment of senile patients with intertrochanteric fracture. Methods 45 cases of senile patients with intertrochanteric fracture were treated with closed reduction under C arm fluoroscopy and PFNA minimally invasive treatment. The treatment effect was observed. Results Patients had operation time as 45~90 min, mean operation time as 60 min, intraoperative bleeding volume as 100~150 ml, mean intraoperative bleeding volume as 120 ml. All the 45 patients were followed up for 6~36 months with an average follow-up of 17 months. One patient died of a sudden myocardial infarction after discharge and one patient fell accidentally after walking and then fractured the distal end of the intramedullary nail. The other fractures were healed, and no complications such as spiral blade cutting, withdrawing, coxa varus and postoperative infection were found. The Harris score of hip function was excellent in 31 cases, good in 9 cases, fair in 5 cases and poor in 0 cases, with an excellent-good rate as 88.9%. Conclusion PFNA minimally invasive treatment is an ideal method for the treatment of senile patients with intertrochanteric fracture.