闭合复位PFNA治疗高龄老年股骨粗隆间骨折

目的评价防旋型股骨近端髓内钉(PFNA)治疗高龄老年股骨粗隆间骨折的疗效,探讨相关并发症及预防措施。方法分析2011年1月—2016年9月采用闭合复位PFNA治疗的高龄老年股骨粗隆间骨折患者114例,其中男性34例,女性80例;年龄83.8岁(75~104岁)。观察手术时间、术中出血量、下地时间、住院时间及术后并发症发生情况,按照Harris评分标准评价疗效。结果术后共97例得到随访,随访时间6~25个月,平均9.7个月。按照Harris评分标准,优58例,良27例,可8例,差4例,优良率87.6%。手术时间、术中出血量、下地时间、住院时间分别为(89.6±17.7)min、(109.8±46.6)m L、(12.1±7.5)d、(23.8±8.0)d。术后并发谵妄7例,肺部感染及泌尿系感染16例,股骨头切割并发髋内翻2例,下肢深静脉血栓2例。结论高龄老年股骨粗隆间骨折治疗难度大,并发症繁多,发生率高。PFNA髓内固定符合生物力学特点,具有微创、固定牢靠、可早期负重活动等优点,疗效满意。

Closed reduction with PFNA in the treatment of femoral intertrochanteric fracture in elderly patients

Objective In order to evaluate the efficacy of PFNA in the treatment of intertrochanteric frac-tures in elderly patients,and to explore the related complications and preventive measures.Methods Data of 114 elderly patients with intertrochanteric fracture were retrospectively analyzed,who were treated with closed reduction from Jan.2011 to Sep.2016.There were 34 males and 80 females,with an average age of 83.8 years(range,75-104).The operation time,intraoperative blood loss,weight-bearing time,hospital stay and postoperative complica-tions were observed.Curative effect was evaluated according to the Harris score standard.Results Totally 97 ca-ses were followed up.The follow-up time ranged from 6 to 25 months,with an average of 9.7 months.Harris score evaluation indicated 58 cases of excellent,27 cases of good,8 cases of fair,4 cases of poor,and the excellent and good rate was 87.6%.The operation time,intraoperative blood loss,weight-bearing time,and the hospital stay were (89.6 ±17.7)minutes,(109.8 ±46.6)mL,(12.1 ±7.5)days,(23.8 ±8.0)days,respectively.After opera-tion,there were 7 cases of delirium,16 cases of pulmonary infection and urinary tract infection,2 cases of femoral head cutting with coax vara,and 2 cases of lower extremity deep venous thrombosis.Conclusion The treatment of elderly femoral fracture patients is very difficult and has many complications.Intramedullary fixation with PFNA ac-cords with biomechanical characteristics and has the advantages of mini -invasiveness,reliable fixation and early weight-bearing activity.