防旋转股骨髓内钉治疗老年不稳定型股骨粗隆间骨折的疗效分析

目的：探讨防旋转股骨近端髓内钉（proximalfemoralnailantirotation，PFNA）治疗老年股骨粗隆间不稳定型骨折的特点、手术方法及初期疗效。方法：选取2008年3月-2012年12月采用PFNA治疗的26例老年股骨粗隆间骨折患者，其中男11例，女15例；年龄65。97岁，平均78．2岁；按照AO分类，A2型16例，A3型10例，患者入院后17例采用皮肤牵引，9例采用骨骼牵引，入院后2-4d实施手术，术中均经骨科下肢牵引床牵引手法复位，小切口置入PFNA，术中不暴露骨折端。结果：本组26例患者平均手术时间55min（40-110min），平均出血量80mL（30～200mL），术后1例因为肺部感染转入内科治疗，合并下肢深静脉血栓患者2例，其余患者康复出院。随访5—48个月，平均20个月，部分负重行走时间2周，完全负重行走时间4周，骨折愈合时间10周。患者均无切口感染、深静脉血栓、内固定松动、髋内翻等并发症。根据Harris髋关节功能评分：优18例，良4例，一般2例，差1例，优良率为84．6％。结论：PFNA结合牵引床治疗老年股骨粗隆间不稳定型骨折具有创伤小、手术操作简单、并发症少、内固定牢固等优势，值得临床推广应用。

Clinical Analysis of Proximal Femoral Nail Anti-rotation in Treatment of Elderly Patients with Unstable Femoral Intertrochanteric Fracture

Objective： To investigate characteristics, surgical methods and initial efficacy of the anti-rotation type proximal nail （ proximal femoral nail antirotation, PFNA ） in treatment of elderly patients with unstable femoral intertroehanteric fracture.Method： 26 elderly patients with unstable femoral intertrochanteric fracture who treated with PFNA from March 2008 to December 2012 were selected, 11 cases were male, 15 cases were female, 65-97 years old, the mean age was 78.2 years.According to AO classification, A2 type was 16 case, A3 was 10 case.After admission, 17 patients were treated with skin traction, 9 patients were treated with skeletal traction.Patients underwent surgery after admission 2-4 d, underwent traction manipulation by lower limb traction bed of orthopaedics in the surgery, PFNA was placed into small incision, in surgery couldn＇ t be exposed fracture.Result： In 26 patients, the average operation time was 55 min （ 40-110 min ）, the average amount of bleeding was 80 mL （ 30-200 mL ）, 1 patient transferred to medical treatment because of lung infection and 2 cases combined deep venous thrombosis （ DVT ）, the remaining patients were discharged from the hospital.Followed up for 5-48 months, an average of 20 months, partial weight-bearing was 2 weeks, the full weight-bearing walking time was 4 weeks, fracture healing time was 10 weeks, patients were no incision infection, deep vein thrombosis, internal fixation loosening and hip varus complications.According to the Harris hip function score： excellent in 18 cases, good in 4 cases, general in 2 cases, poor in 1 case.the excellent.and good rate was 84.6%.Conclusion： PFNA combined with traction bed treatment of unstable intertrochanteric femoral fractures has less trauma, simple operation, less complications, internal fixation and other advantages, is worthy of clinical application.