早期闭合复位PFNA内固定治疗老年股骨转子间骨折

Early closed reduction and internal fixation with proximal femoral nail anti-rotation for intertrochanteric fracture in the elderly

[目的]观察早期闭合复位股骨近端防旋髓内钉内固定治疗老年股骨转子间骨折的临床疗效及安全性。[方法]2010年6月~2016年10月,156例老年不稳定型股骨转子间骨折患者采用早期闭合复位PFNA内固定治疗,参照Tronzo-Evans分类方法,均为Ⅲ、Ⅳ型骨折。观察患者手术时间、术中失血量、并发症、愈合时间及髋关节功能恢复情况。[结果]手术时间18~46 min,平均25 min;术中显性失血量65~160 ml,平均110 ml。155例患者获随访,随访时间5~18个月,平均12个月。所有骨折均达骨性愈合,愈合时间10~26周,平均17周,无骨折不愈合、髓内钉断裂、切割、切出、切口感染,10例出现肺部感染、15例出现泌尿系统感染、8例出现下肢深静脉血栓、5例出现肺栓塞,1例肺栓塞患者死亡,其余均经治疗后痊愈。末次随访时采用Harris髋关节功能评分标准评定疗效,优128例、良19例、可8例。[结论]早期闭合复位PFNA内固定治疗老年股骨转子间骨折安全性高、骨折愈合率高、并发症少、髋关节功能恢复良好。

[Objective] To evaluate the clinical efficacy and safety of early closed reduction and internal fixation with proxi- mal femoral nail antirotation （PFNA） for intertroehanterie fracture in the elderly. [Method] From June 2010 to October 2016, 156 patients with unstable intertrochanterie fractures were treated with early dosed reduction and internal f＇Lxation with PFNA. According to the Tronzo-Evans classification, all the fractures belonged to Type III and IV. The time elapsed from injury to sur- gery proved froml2 to36 hours with an average of 22 hours ,The operation time, intraoperative blood loss, complication, fracture healing time and the hip function were evaluated. [Results] All the patients received operation successfully with operation time of 25 minutes on average ranged from 18 to 46 minutes, and intraoperative dominant blood loss of llOml ranged from 65 to 160ml. All the 156 patients were followed up for a mean of 12 months ranged from 5 to 18 months. All the fractures gained bony union for 10 to 26 weeks with a mean of 17 weeks. No nonunion, failure of internal fixation occurred in any patient, al- though 10 patients got pulmonary infection, 15 had urinary tract infection, 8 had deep vein thrombosis, and 5 had pulmonary em- bolism, all the patients were cured after proper treatment except for 1 patient died of pulmonary embolism. Aceording to the Har- ris hip function scoring criteria, 128 patients were graded as excellent, 19 as good, and 8 as fair at the latest follow-up. [Conclu- sion] Early dosed reduction and internal fixation with PFNA for intertroehanteric fracture in the elderly is safe technique with higher fracture healing rate, less complication and improved hip joint function.