股骨近端髓内钉PFN-A治疗老年不稳定股骨粗隆间骨折

目的评估股骨近端髓内钉PFN-A治疗不稳定股骨粗隆间骨折的临床疗效。方法2007~2009年42例不稳定股骨粗隆间骨折患者按AO分类,31-A2型23例,31-A3型19例。使用PFN-A治疗,统计术中失血量,手术时间,骨折愈合时间,髋关节功能评价。结果本组患者术中平均失血量小于100ml,平均手术时间1h。术后随访6～24个月,全部骨折均愈合,除1例在术后2个月出现髓内钉远端的股骨干骨折,80%的患者在术后六个月恢复术前的患髋关节功能,无股骨头缺血坏死及髋内翻畸形。结论股骨近端髓内针PFN-A治疗股骨粗隆间骨折具有手术简单、固定牢稳、微创、并发症少的特点,尤其适用于骨质疏松的老年患者,是目前治疗不稳定型股骨粗隆间骨折较为合适的治疗方法。

Surgical Treatment of Unstable Femoral Intertrochanteric Fractures with Proximal Femoral Nail-A in Elderly Chinese Patients

Objective To evaluate the therapeutic effect of proximal femoral nail-A(PFN-A)in unstable femoral intertrochanteric fractures.Methods From 2007 to 2009,42 patients with unstable trochanteric fractures(AO/ASIF classification:31.A.2 and A.3 only)were treated with PFN-A instrumentation by means of closed reduction and fixation.Blood loss,operation time,fracture healing and functional re-covery of the hip joints were observed.Results The mean blood loss was less than 100 m1 and the mean operation time was 60 min,fol-low-up from 6 to 24 months after operation showed union of fracture in all cases.Only a case of periprosthetic femoral fractures was found 2 months after operation because of slipping accident.Eighty percent of the patients regained the pre-trauma mobility.No case of ischemia and necrosis of femoral head,malformation of hip and hip varus were observed.Conclusion The clinical treatment of unstable femoral in-tertrochanteric fractures with PFN-A is convenient,stable,mini invasive and almost free from complications,which is applicable to patients of osteoporosis.PFN-A may be the more appropriate instrumentation for treatment of unstable femoral intertrochanteric fractures.