股骨近端防旋髓内钉治疗老年股骨转子间骨折

Treatment of elderly femoral intertrochanteric fractures with proximal femoral nail anti-rotation

目的探讨股骨近端防旋髓内钉(PFNA)治疗老年股骨转子间骨折的疗效。方法采用PFNA治疗216例老年股骨转子间骨折患者。记录手术时间、术中出血量、术后骨折复位情况、骨折愈合情况。采用Harris评分评价髋关节功能。结果死亡9例,其余207例均获得随访,时间3~14个月。手术时间35~131(43.31±11.26)min,术中出血量80~350(150.28±42.19)ml。术后骨折复位情况:良好81例(39.1%),尚可94例(45.4%),欠佳32例(15.5%)。骨痂形成时间1.5~6.0(2.31±1.02)个月,骨折愈合时间3.0~8.0(3.23±1.56)个月。末次随访时,164例可完全负重行走,43例可扶拐部分负重行走;采用Harris评分评价髋关节功能:优132例,良45例,可22例,差8例,优良率85.5%。结论采用PFNA治疗老年股骨转子间骨折,具有创伤小、手术时间短、患者术后功能恢复快等优点,临床疗效满意。

Objective To investigate the effect of proximal femoral nail anti-rotation(PFNA)in the treatment of elderly femoral intertrochanteric fractures.Methods The 216 elderly patients with femoral intertrochanteric fractures were treated with PFNA.The operation time,intraoperative blood loss,fracture reduction,fracture healing time of postoperative situations were recorded.Harris hip function score criteria was used to evaluate the curative effect.Results The 9 patients died,and the remaining 207 patients were followed up for 3~14 months.The operation time was 35~131(43.31±11.26)min,the intraoperative blood loss was 80~350(150.28±42.19)ml.The situation of postoperative fracture reduction was excellent and good in 81 cases(39.1%),fair 94 cases(45.4%),and poor 32(15.5%).The callus formation time was 1.5~6.0(2.31±1.02)months,the healing time of fracture was 3.0~8.0(3.23±1.56)months.At the last follow-up,164 patients could walk with full weight-bearing and 43 cases could walk with partial weight-bearing with crutches;the efficacy was assessed with Harris hip function score criterion:132 cases were excellent,45 cases good,22 fair,8 poor,and excellent-good rate was 85.5%.Conclusions The treatment of elderly femoral intertrochanteric fracture with PFNA has the advantages of less trauma,shorter operation time and fast postoperative functional recovery.The clinical effect is satisfactory.