微创小切口闭合复位PFNA内固定术治疗老年股骨粗隆间骨折

目的探讨采用微创小切口闭合复位PFNA内固定治疗老年股骨粗隆间骨折的临床疗效。方法 2009年5月~2013年11月采用微创小切口闭合复位PFNA内固定治疗老年股骨粗隆间骨折83例,平均年龄72.3(65~82)岁。结果本组手术时间平均56(38~69)min,术中显性出血量平均60(40~100)ml,术中输血平均400(0~800)ml。77例术后恢复顺利,切口均一期愈合,术后无感染、坐骨神经损伤、脂肪栓塞等并发症。术后出现下肢静脉血栓5例,肺栓塞1例。本组83例患者均获随访,平均随访27(3~41)个月,骨折均愈合。所有患者生活均能基本自理,关节活动度明显改善。2例出现髋内翻。术后根据Harris评分评定疗效[4]:优68髋,良9髋,中6髋,优良率92.8%。结论采用微创小切口闭合复位PFNA内固定术治疗老年股骨粗隆间骨折手术创伤小,出血少,手术时间短,固定可靠,临床效果较为理想。

Closed Reduction and Minimally Invasive Internal Fixation with Proximal Femoral Nail Anti-rotation for Femoral Intertrochanteric Fracture in Elderly Patients

Objective To evaluate the clinical effect of closed reduction and minimally invasive internal fixation with proximal femoral nail anti-rotation （PFNA） in the treatment of femoral intertrochanteric fracture in elderly patients. Method The clinical data of 83 femoral intertrochanteric fracture cases, aged from 65 to 82 years old （average 72.3）, admitted from May 2009 to November 2013 were analyzed retrospectively. Results The operative duration was 38 to 69 minutes （mean 56）, the intra-operative blood loss was 40 to 100 ml （mean 60 ml）, and the blood transfusion volume was 0 to 800 ml （ mean 400 ml）. 77 cases obtained satisfied post-operative recovery without complication such as post-operative infection, injury of sciatic nerve or fat embolism. Vein thrombus in lower limb was found in 5 cases and pulmonary embolism in 1 case. All fractures were healing during 3 to 41 months follow-up. Coxa vara was occurred in 2 cases. According to Harris score, the outcome was revealed excellence in 68 hips, good in 9 hips and fair in 6 hips, and the fineness rate was 92.8%. Conclusion Closed reduction and minimally invasive PFNA internal fixation can achieve a satisfactory effect with minimally surgical trauma, less blood loss, short operative time and rigid fixation for femoral intertrochanteric fracture in elderly patients.