应用PFNA治疗39例老年人股骨粗隆间骨折

目的探讨老年人股骨粗隆间骨折采用股骨近端防旋髓内钉(PFNA)内固定的临床疗效。方法2008年1月～2011年4月,我院收治的老年人股骨粗隆间骨折并应用PFNA手术治疗39例,年龄为52～88岁,平均年龄为68.2岁,对手术持续时间、骨折复位情况、术中出血量、PFNA螺旋叶片位置及颈干角、术后患髋功能进行了记录评估。结果 39例获得随访,随访时间8～12个月(1.5、3、6、9、12月),平均10.1月;骨折均愈合,37例成功闭合复位,2例切开复位;手术时间平均为75 min。术中失血量平均为98 ml;骨折复位良好37例,一般2例;螺旋叶片位于股骨头颈的中间位置为33例,颈干角平均为127.8°;30例达到骨折愈合时间为12～24 w;术后患髋关节功能优良36例,可3例,无术后感染及内固定移位折断等。结论采用闭合复位PFNA内固定治疗股骨粗隆间骨折具有操作简单、出血量少、手术时间短、骨折固定可靠、并发症少等优点,提示PFNA适合合并症多的高龄股骨粗隆间骨折患者,值得推广应用。

TREATMENT FOR 39 SENILE INTERTROCHANTERIC FEMORAL FRACTURES WITH THE PFNA

Objective To evaluate the clinical effects of internal fixation with the proximal femoral nail antirotation blade(PFNA) for senile intertrochanteric femoral fractures. Methods Between January 2008 and April 2011,39 elderly patients with intertrochanteric femoral fractures,aged from 52 to 88 years with average of 68.2 years were treated with the proximal femoral nail antirotation blade(PFNA).The operation durations,amount of intra-operative bleeding,the quality of fracture reduction,PFNA blade position,neck shaft angle were recorded.Hip function was assessed after rehabilitation period. Results Follow-up to union was achieved for 39 patients.The mean follow-up period was 10.1 months range 8-12 months.All fractures were healed.Closed reduction was successful in 37 patients and 2 patients required open reduction.The operation durations averaged 75 minutes and intra-operative blood loss averaged 98 ml.Fracture reduction was good in 30,acceptable in 7 and poor in 2 patients.PFNA blade position was central in 33 patients.Mean post-operative neck shaft angle was 128.9°.30 fractures united between 12 and 24 weeks.According to the Harris scoring system,36 cases were excellent and 3 cases were good.There was no infection and blade cut out. Conclusion Treatment of senile intertrochanteric femoral fractures with closed reduction and internal fixation with the PFNA offers the advantages of technically simple procedure,less blood loss,shorter operation duration,firmly stable fixation,less complications and satisfied clinical effects.