PFN内固定治疗80岁以上老年骨质疏松性股骨转子间骨折

目的探讨股骨近端髓内钉（PFN）治疗80岁以上老年骨质疏松性股骨转子间骨折的初期疗效。方法总结2007年1月-2008年12月PFN内固定治疗老年骨质疏松性转子间骨折37例。28例合并两种以上内科疾病,7例合并1种内科疾病。所有病例均经牵引床牵引、闭合复位,术中不显露骨折区域,小切口置入PFN。结果37例中,1例术后因严重的心衰、肺气肿病情加重于术后第17天死亡。30例伤肢基本恢复了伤前的功能,4例因膝关节骨性关节炎、脑栓塞、肺心病等并存病的加重,患肢功能较伤前减退,需助行器辅助行走。X线显示36例存活的病例骨折全部一期愈合,平均愈合时间为9周（4-14个月）。所有存活病例均无感染、骨不连、内固定失效等并发症。结论PFN治疗老年骨质疏松性股骨转子间骨折的初期疗效较好,内固定可靠,允许早期功能锻炼。

Effect of PFN fixator for osteoporotic intertrochanter fractures in elderly patients

Objective To evaluate the preliminary usage of PFN in surgical treatment of intertrochanter fractures caused by osteoporosis in patients over 80 years old. Methods Thirty-seven patients with comminuted intertrochanter fractures caused by osteoporosis were treated with PFN. Seven patients combined with one kind of medical disease and 28 patients with two more medical diseases. Bone fracture sector was not dissected during the operation and PFN was implanted by mini-incision. Results One patient died of severe congestive heart failure and emphysema in the 17th clay after operation. The functional recovery was achieved in 30 patients. Functional weaken in affected limb was observed in 4 patients because of the aggravation of osteoarthritis in knee, cerebral embolism and pulmonary heart disease, et al. The X-ray pictures showed that unions were achieved in all 36 lived patients and the mean healing time was 9 weeks （4 to 14 months）. No complications such as infection, non-union, loosing of nails were found in 36 lived patients. Conclusion The PFN could make a good fixation in the treatment of unstable intertrochanter fractures caused by osteoporosis in elderly patient. It allowed the patients to take exercise early and achieved an excellent clinical outcome.