PFNA治疗高龄股骨粗隆间骨折的研究进展

Research progress of PFNA in the treatment of elderly femoral intertrochanteric fractures

股骨粗隆间骨折多与骨质疏松有关,近年来发病率越来越高,逐渐成为骨科临床研究的热点。股骨粗隆间骨折患者具有发病年龄高、骨折不稳定、合并症多、骨质差的特点,保守治疗因卧床时间长,通常会导致坠积性肺炎、下肢深静脉血栓、压疮等并发症,有较高的致残率和致死率。近年来,股骨近端防旋髓内钉(PFNA)广泛应用于各种类型股骨粗隆间骨折治疗,取得了成功,相比动力髋螺钉等髓外固定系统,PFNA具有固定效果好、手术时间短、手术创伤小、固定牢靠等优势,尤其适合合并症较多、手术耐受力较差的高龄患者以及合并骨质疏松的患者。但是也存在内固定失效、下肢深静脉血栓形成、术后大腿部位的疼痛、骨折线不愈合等问题。本文对股骨粗隆间骨折临床上常用的骨折分型进行了综述,并综合分析PFNA治疗股骨粗隆间骨折的优缺点,阐述手术操作步骤及技巧、要点和手术常见并发症,以期为今后的临床工作提供参考。

Intertrochanteric fractures of the femur are mostly related to osteoporosis.In recent years,the incidence rate is getting higher and higher,and it has gradually become a hot spot in orthopaedic clinical research.Patients with intertrochanteric fractures of the femur are characterized by a high age of onset,unstable fractures,many complications,and poor bone quality.Conservative treatment usually leads to complications such as falling pneumonia,deep vein thrombosis of the lower limbs and bedsores due to long bedtime.There is a high rate of disability and fatality.In recent years,PFNA has been widely used in the treatment of various types of femoral intertrochanteric fractures,and has achieved great success.Compared with extramedullary fixation systems such as dynamic hip screws,PFNA has better fixation effects,shorter operation time,less surgical trauma,and reliable fixation,especially suitable for elderly patients with more comorbidities,poor surgical tolerance and patients with osteoporosis.However,there are also problems such as failure of internal fixation,deep vein thrombosis of the lower extremities,postoperative pain in the thigh area,and non-union of the fracture line.This article summarizes the clinically commonly used fracture classifications of femoral intertrochanteric fractures,and comprehensively analyzes the advantages and disadvantages of PFNA in the treatment of femoral intertrochanteric fractures,elaborates the surgical procedures,skills,key points,and the common complications of the operation.It hopes to provide some reference for clinical work.