探讨闭合复位后PFNA内固定治疗高龄股骨粗隆间骨折的临床疗效

Discussion on clinical efficacy of closed reduction and PFNA internal fixation for intertrochanteric fracture of femur in the elderly

目的探讨闭合复位后采用股骨近端防旋髓内钉(PFNA)内固定治疗高龄股骨粗隆间骨折的临床疗效。方法选取206例高龄股骨粗隆间骨折患者作为研究对象,所有患者均采用闭合复位PFNA内固定治疗。观察统计患者手术时间、术中出血量、并发症发生情况、围手术期死亡情况、骨折愈合情况、髋关节功能恢复情况及治疗效果。结果手术时间为30~80min,术中出血量为100~220ml。术后发生肺部感染27例,经呼吸内科治疗后好转,无围手术期死亡病例。患者均获随访,时间4~6个月,其中15例于术后4个月内死于内科疾病,其他患者骨折全部愈合,愈合时间为3~5个月,183例(95.8%)患者恢复至术前功能状态。均无下肢深静脉血栓形成、螺旋刀片切割及患肢缩短等不良事件发生。髋关节功能恢复优103例,良77例,差11例,优良率为94.2%。结论闭合复位PFNA内固定治疗高龄股骨粗隆间骨折手术时间短,术中出血量少,术后并发症少,患者髋关节功能恢复满意。

Objective To discuss the clinical efficacy of closed reduction and proximal femoral nail antirotation(PFNA)internal fixation for intertrochanteric fracture of femur in the elderly.Methods There were 206 elderly patients with intertrochanteric fracture of femur as study subjects,and all received closed reduction and PFNA internal fixation.Their operation time,amount of intraoperative hemorrhage,occurrence of complications,perioperative mortality,fracture healing,hip function recovery and therapeutic effect was observed.Results The operation time was 30-80 min and the amount of intraoperative hemorrhage was 100-220 ml.Postoperative pulmonary infection occurred in 27 cases,which improved after treatment by respiratory medicine without perioperative deaths.All patients were followed up for 4-6 months,of which 15 cases died of medical diseases within 4 months after operation.All the other fractures healed in 3-5 months after follow-up.183 patients(95.8%)recovered to preoperative functional status,and no adverse events such as deep venous thrombosis,spiral blade cutting and limb shortening occurred.The recovery of hip function was excellent in 103 cases,good in 77 cases,poor in 11 cases,and the excellent-good rate was 94.2%.Conclusion Closed reduction and PFNA internal fixation for the treatment of intertrochanteric fracture of femur in the elderly has shorter operation time,less amount of intraoperative hemorrhage,fewer postoperative complications and satisfactory recovery of hip function.