微创手术治疗老年性不稳定股骨粗隆间骨折的临床观察

目的观察抗旋转股骨近端髓内钉(Proximal femoral nail antirotation,PNFA)微创手术治疗老年不稳定股骨粗隆间骨折的临床疗效。方法自2010年5月至2011年6月回顾性研究老年性不稳定股骨粗隆间骨折35例,男9例,女26例,年龄65～92岁,平均74.3岁。按改良Jensen-Evans分型:ⅢA型14例,ⅢB型9例,Ⅳ型2例。均合并不同程度的骨质疏松。在C型臂透视下闭合复位经皮小切口PFNA内固定治疗。结果手术时间45～85min,平均63.9min;术中出血50～150ml,平均80ml,手术切口3～6cm,平均5cm。随访时间6～12个月,平均8.7个月。骨折全部愈合,愈合时间9-18周,平均12.5周。按Harris髋关节功能评分标准:优25例,良8例,可2例,优良率为94.3%。结论经皮微创PFNA治疗老年性不稳定股骨粗隆间骨折疗效良好,具有骨折固定牢固,创伤小,术后并发症少等优点。

The study on clinical effectiveness of minimally invasive operating procedures for unstable femoral intertrochanteric fracture in aged patients

Objective To explore clinical effectiveness of minimally invasive operating procedures with proximal femoral nail antirotation(PNFA) for unstable femoral intertrochanteric fracture in aged patients.Methods In a prospective study 35 aged patients with unstable femoral intertrochanteric fracture were teated with PFNA fixation under the guidance of fluoroscopy,closed reduction,minimally invasive incision from May 2010 to June 2011.They were 9 males and 26 females,with an average age of 74.3(65 to 92 years)years.According to Jensen-Evans classification.there were 14 cases of ⅢA,9ⅢB,and 2Ⅳ.Results 35 patients were foHowed up for 6~12 months(averaged 8.7 months).Fracture union Was achieved in alI patients with a mean healing time of 12.5(9 to 18)weeks.According to Harris criterion,the resuIts of 25 exceIIent cases and 8 good cases were obtained.The excellent and good rate of the function of the hip joint was 94.3%.Operation time 45~85 minutes(aveaged 63.9 minutes),Operation bleeding 80~250 ml(averaged 130 ml),Operative incision 3~6 cm(averaged 5 cm) Conclusion Minimally invasive operating procedures with proximal femoral nail antirotation(PNFA) for unstable femoral intertrochanteric fracture in aged patients is a useful treatment.It has advantages of less surgical trauma,stabIe fixation,less complications.