解剖型股骨近端髓内钉治疗老年股骨粗隆间骨折的早期疗效分析

The clinical efficacy of Zimmer Natural Nail for treatment of femoral intertrochanteric fracture in the elderly

目的探讨解剖型股骨近端髓内钉(Zimmer Natural Nail,ZNN)治疗老年股骨粗隆间骨折的早期临床疗效。方法回顾性分析2016年6月至2017年1月北部战区总医院收治的26例老年股骨粗隆间骨折患者的临床资料,男15例,女11例;年龄65～92岁,平均(77.7±7.9)岁;左侧11例,右侧15例。根据Evans-Jensen分型,ⅠA型1例,ⅠB型9例,ⅡA型3例,ⅡB型8例,Ⅲ型5例。所有患者均采用闭合复位ZNN内固定治疗。记录患者的手术时间、术中失血量、围术期并发症、骨折愈合时间及术前与末次随访时Charnley髋关节功能评分。结果本组26例患者均获随访,时间12～24个月,平均(18.2±3.4)个月。1例术后因低蛋白致切口长期渗出,经换药后切口愈合良好,余无围术期并发症发生。平均手术时间为(64.5±10.6)min,术中失血量为(87.2±35.6)ml,骨折愈合时间为(17.2±2.3)w。术前与末次随访时Charnley髋关节功能评分分别为(4.0±0.7)分与(15.7±2.0)分,差异具有统计学意义(t=27.5,P<0.01)。结论 ZNN治疗老年股骨粗隆间骨折围术期并发症少、骨愈合率高、术后髋关节功能恢复良好,早期临床疗效确切。

Objective To investigate the early clinical efficacy of Zimmer Natural Nail( ZNN) for treatment of femoral intertrochanteric fracture in the elderly. Methods From June 2016 to January 2017,26 cases of elderly patients with femoral intertrochanteric fractures in Northern Theater General Hospital were restrospectively reviewed. There were 15 males and 11 females( 11 cases on the left side and 15 cases on the right),with a mean age of( 77. 7 ± 7. 9) years old( range 65 to 92 years old). According to the Evans-Jensen classfication,1 case of TypeⅠA,9 of TypeⅠB,3 of Type ⅡA,8 of Type ⅡB and 5 of Type Ⅲ. All patients are treated with closed reduction and ZNN fixation. The operation time,intraoprative blood loss,perioperative complications,fracture healing time and preoperative and final follow-up of Charnley score were recorded. Results The 26 patients were followed up for an average time of ( 18. 2 ± 3. 4) months( range 12 to 24 months). 1 patient suffered long-term exudation of the incision due to low protein after surgery,and the incision finally healed well after several dressing change. The mean operation time was( 64. 5 ± 10. 6) min,the mean intraoprative blood loss was( 87. 2 ± 35. 6) ml and the mean time of fracture healing was( 17. 2 ± 2. 3) w. The preoperative and last follow-up of Charnley score were( 4. 0 ± 0. 7) and( 15. 7 ± 2. 0) respectively. The difference in Charnley scores was statistically significant ( t = 27. 5,P < 0. 01). Conclusion For the treatment of elderly patients with femoral intertrochanteric fractures,ZNN has the advantages,less perioperative complications,high rates of fracture healing and good postoperative recovery of hip joint function. The early clinical effect was definite.