髓内固定在高龄不稳定转子间骨折治疗中的应用

目的:探讨Gamma钉、PFN(proximal femoral nail)及PFNA(proximal femoral nail anti-rota-tion)在高龄不稳定转子间骨折治疗中的初步应用及疗效比较。方法:我院2003年12月~2009年8月分别采用Gamma钉、PFN及PFNA治疗高龄不稳定转子间骨折患者79例,其中Gamma钉组22例、PFN组38例、PFNA组19例,对3组疗效进行回顾性总结分析。结果:Gamma钉组2例死亡,77例均完成平均18个月随访,各组间手术时间及术中出血量比较差异有统计学意义(P<0.05),PFNA组平均手术时间(45.2±7.8)min,平均术中出血量(148.4±30.0)mL,均比其它两组明显减少(P<0.05);术后引流量、临床骨折愈合时间、术后关节功能评分和手术并发症等指标各组间比较差异无统计学意义(P>0.05);术后关节Sanders功能评分:Gamma钉组、PFN组、PFNA组优良率分别为85.0%、86.8%、89.5%,3组差异无统计学意义(P>0.05)。结论:PFNA手术创伤小、手术时间短、固定牢靠,较为适合高龄不稳定转子间骨折的治疗,但其远期临床疗效与Gamma钉及PFN组并无显著差异。

Comparison of intramedullary fixation system in the treatment of unstable intertrochanteric fracture of aged patients

Objective：To compare preliminary application and therapeutic effect of Gamma nail,PFN and PFNA in the treatment of unstable intertrochanteric fracture in aged patients.Methods：A review study was conducted on 79 aged patients with unstable intertrochanteric fractures from December 2003 to August 2009,including 22 cases treated with Gamma nail,38 treated with PFN and 19 treated with PFNA.Results：Two cases died in Gamma snail group,and other 77 cases were followed-up for 18 months in average.There were significant differences in the operating time and the blood loss among the 3 groups（P0.05）.Average operating time （45.2±7.8） min] and the average bleeding volume during surgery（148.4±30.0）mL]of PFNA group were significantly less than those of other 2 groups（P 0.05）.And the differences in postoperative drainage,clinical bone healing time,joint functional scores and operative complications were not significant（P 0.05） among the 3 groups.Sanders score showed excellent and good rate were 85.0% in Gamma nail group,86.8% in PFN group,and 89.5% in PFNA group,without significant difference（P 0.05）.Conclusions：PFNA can shorten operative time,reduce surgical trauma and make internal fixation firmly.It is appropriate treatment for unstable intertrochanteric fracture in aged patients.But its long-term clinical effect is similar with the results of Gamma nail and PFN.