防旋股骨近端髓内钉微创治疗老年股骨转子间骨折临床研究

目的：探讨股骨近端防旋髓内钉（PFNA）微创治疗老年患者股骨转子间骨折的临床疗效。方法：回顾性分析2008年2月～2009年8月收治的58例62岁以上老年不稳定型股骨转子间骨折患者进行PFNA治疗的临床资料。按照Tronzo-Evans分型：I型6例,Ⅱ型11例,Ⅲ型25例,Ⅳ型16例,闭合复位并小切口置入PFNA。结果：手术时间28.7～66.3 min,平均48.7 min。术中出血量62～200 mL,平均100.3 mL。47例随访6～13个月,平均7.5月,骨折全部愈合,愈合时间为3.2～7.4个月,平均4.1个月。1例出现下肢深静脉血栓,3例出现髋内翻。余未出现其它并发症,髋、膝及踝关节功能良好。结论：PFNA治疗老年人不稳定型股骨转子间骨折。具有操作简单、创伤小、骨折固定牢固、并发症少及术后患者可早期离床负重等优点。

Effect of Proximal Femoral Nail Anti-rotation in Treatment of Femoral Intertrochanteric Fractures in the Elderly

Objective： To investigate the curative effect of proximal femoral nail anti-rotation（PFNA） in treatment of femoral intertrochanteric fractures in the elderly.Methods： Retrospective analysis clinical data from February 2008 to August 2009,58 unstable femoral intertrochanteric fractures patients over 62 years old were treated with PFNA.The distribution of Tronzo-Evans stages was stage Ⅰ in 6 hips,stage Ⅱ in 11 hips,stage Ⅲ in 25 hips,and stage Ⅳ in the remaining 16 hips.They were closed replacement and then inserted PFNA with mini-incision.Results： The average operation time was 48.7 mins（range 28.7～66.3mins）,and the average blood loss was 100.3ml（range 62～200ml）.Forty-seven cases were followed up for 7.5 months averagely（range 6～13 months）.They were all fractures healed,and the bone healing time was 4.1 months averagely（range 3.2～7.4 months）.Unfortunately,one case appeared deep vein thrombosis and 3 cases appeared coxa vara.The others＇ hip,knee,and ankle joints function were well without any complications. Conclusion： PFNA is effective for unstable femoral intertrochanteric fractures in the elderly for it is characterized by simple operation,minimal trauma,stable fixation,and fewer complications,early to begin weight bearing post-operation,and so on.