抗旋转股骨近端髓内钉治疗老年骨质疏松性股骨粗隆间骨折的疗效

目的:评价抗旋转股骨近端髓内钉(proximal femoral nail anti-rotation,PFNA)治疗老年骨质疏松性股骨粗隆间骨折的疗效。方法:2008年6月—2011年3月采用PFNA治疗老年骨质疏松性股骨粗隆间骨折患者38例,年龄64~93岁,中位年龄72岁;根据AO/ASIF分型,A1型11例,A2型21例,A3型6例。38例骨折均经闭合复位,采用小切口置入PFNA。结果:38例患者术后切口均Ⅰ期愈合,2例术后出现肺部感染。38例患者中,术后骨折复位良好27例,可9例,差2例;34例螺旋刀片位置满意;尖顶距(tip-apex distance,TAD)10 mm 15例,10~20 mm 20例,20 mm 3例。38例骨折均愈合,愈合时间13~22周,平均(16.3±2.4)周。根据Harris髋关节功能评分标准:优24例,良9例,中5例。有1例术后3个月时发现螺旋刀片头部穿透股骨头关节面。结论:PFNA能挤压增强股骨头内的松质骨,抗旋转稳定性好,是治疗老年骨质疏松性股骨粗隆间骨折的理想内固定物。

Efficacy of Proximal Femoral Nail Anti-Rotation in the Treatment of Femoral Intertrochanteric Fractures Caused by Senile Osteoporosis

Objective：To evaluate the efficacy of proximal femoral nail anti-rotation（PFNA） in the treatment of femoral intertrochanteric fractures caused by senile osteoporosis.Methods：From Jun 2008 to Mar 2011,38 patients with femoral intertrochanteric fractures caused by senile osteoporosis were treated with PFNA.The ages ranged from 64 years to 93 years with a median age of 72.6 years.According to AO/ASIF classification,11 fractures were type A1,21 fractures were type A2 and 6 fractures were type A3.All patients were treated with closed reduction and PFNA were inserted with minimal incision.Results：The incision healed by first intention in all patients.Two patients suffered from pneumonia after the operation.The quality of fracture reduction was good in 27 patients,acceptable in 9 patients and poor in 2 patients.The positions of the PFNA blade were ideal in 34 patients.The tip-apex distance（TAD） was 〈10 mm in 15 patients,10-20 mm in 20 patients and 〉20 mm in 3 patients.Fracture healing occurred in all patients,and the healing period ranged from 13 to 22 weeks with a mean healing period of （16.3 ± 2.4） weeks.The Harris Hip scores were excellent in 24 cases,good in 9 cases and fair in 5 cases.It was observed that 1 patient＇s PFNA blade perforated through femoral head into the hip joint at 3 months after the operation.Conclusions：PFNA has the excellent anti-rotation stability by compacting the cancellous bone around the blade in the femoral head.It is an ideal internal fixation device for femoral intertrochanteric fracture caused by senile osteoporosis.