PNFA内固定术治疗老年股骨粗隆间骨折疗效观察

Clinical Observation of PNFA Internal Fixation in the Treatment of Senile Intertrochanteric Fracture

目的探讨对老年股骨粗隆间骨折患者采用抗旋转股骨近端髓内钉(PNFA)内固定术进行治疗后获得临床效果。方法回顾分析我院2018年1月—2020年1月收治的65例老年股骨粗隆间骨折患者,临床均选择抗旋转股骨近端髓内钉(PNFA)内固定术,对患者治疗优良率、负重时间、手术时间、术中失血量进行观察。结果所有患者骨折均愈合,骨折愈合时间为(9.78±1.65)w,其中有3例术后半年左右因内科疾病去世,有2例患者出现后期复位丢失,出现轻度髋内翻畸形,1例患者出现股骨头切割,无内固定断裂。按照Harris评分标准:评估患者关节功能,优90~100分,良80~89分,可70~79分,差<70分。其中:优40例,良21例,可3例,差1例,优良率93.8%。结论PNFA内固定术治疗老年股骨粗隆间骨折创伤小、手术时间短,固定可靠,能有效促进骨折愈合,为患者早期离床创造了条件。但因为股骨粗隆局部呈现出丰富血运,手术后通常表现出较短功能恢复时间,对此在进行术式选择期间,需要依据患者具体身体情况以及病情状况合理进行对应术式选择,将患者治疗损伤最大限度减轻,对于患者术后早期康复进行显著促进,充分发挥PNFA内固定术运用于老年股骨粗隆间骨折疾病治疗中临床价值。

Objective To investigate the clinical effect of anti rotation proximal femoral nail(PNFA)internal fixation in elderly patients with intertrochanteric fracture.Methods 65 Elderly Patients with intertrochanteric fracture in our hospital from January 2018 to January 2020 were retrospectively analyzed.All patients were treated with anti rotation proximal femoral nail(PNFA)internal fixation.The excellent and good rate of treatment,weight-bearing time,operation time and intraoperative blood loss were observed.Results The fracture healing time of all the patients was(9.78±1.65)W,among which 3 patients died of medical diseases about half a year after surgery,2 patients had late reduction loss and mild coxa varus deformity,and 1 patient had femoral head cutting without fracture of internal fixation.According to The Harris score(references not included in the abstract):the joint function of the patients was evaluated,with 90~100 points for excellence,80~89 points for excellence,70~79 points for excellence,and<70 points for difference.Among them,there were 40 excellent cases,21 good cases,3 good cases and 1 poor case,with excellent and good rate of 93.8%.Conclusion PNFA internal fixation for the treatment of senile intertrochanteric fractures has small trauma,short operation time,reliable fixation,and can effectively promote fracture healing,creating conditions for patients to leave the bed early.But because the femoral trochanter local present a rich blood supply,usually after the operation showed shorter function recovery time,during operation select,specific physical condition and should be based on patients condition is reasonably select the corresponding operation,will treat damage utmost reduce the patients,significantly promote the early postoperative rehabilitation for the patient,give full play to the PNFA fixation used in treatment of the elderly femoral intertrochanteric fracture disease clinical value.