防旋型股骨近端髓内钉治疗高龄不稳定股骨粗隆间骨折的临床研究

目的探讨防旋刊股骨近端髓内钉（PFNA）在治疗高龄不稳定股骨粗隆间骨折中的疗效。方法2007年9月-2010年3月采用闭合复位PFNA内同定法治疗75岁以上高龄不稳定股骨粗隆间骨折患者41例，其中男20例，女21例。根据Evans分型骨折类型：Ⅲ型25例，Ⅳ型16例。受伤至手术时间1～14d，平均6d。术后复查x线片并进行功能柃查，采用Sanders评分标准进行临床评价。结果所有患者术后伤口均Ⅰ期愈合，无感染及死亡病例。41例中38例得到随访，随访时间4～18m（平均12m）。术后愈合时间3～6m，无内固定断裂、螺旋刀片拔出或穿透股骨头关节面等并发症发生。根据Sanders髋关节创伤股骨粗隆间骨折的评定标准，获优11例、良24例、中3例，优良率92．11％。结论闭合复位PFNA内同定法具有操作时间短、出血少、患者康复快、并发症少等优点，是治疗75岁以上高龄不稳定粗隆问骨折的理想方法。

Analysis on the proximal femoral nail anti-rotation in the treatment of the elderly patients with unstable intertrochanteric fractures of femur

Objective To investigate and evaluate the clinical outcome of the proximal femoral nail anti-rotation （PFNA） in the treatment of unstable intertrochanteric fractures of the femur in elderly patients. Methods From September 2007 to March 2010, 41 cases of intertrochanteric region of the femur were treated by closed reduction and fixation with PFNA, including 20 males and 21 females with age 〉t75 years. According to Evans classification, there were 25 cases of nI type, and 16 cases of IV type, respectively. The time from injure to operation was from 1 to 14 days, with an average of 6 days. The clinical and radiological examinations were done after operation, and the clinical outcomes were evaluated ac- cording to the Sanders scoring. Results All cases were healed with first intention without any infection or death. 38 of 41 cases were followed up for 4 to 18 months （means 12 months）. All fractures were healed uneventfully after 3 to 6 months. No complications such as cut-out or breakage of the implants occurred. According to the Sanders criteria, the clinical results were excellent in 11 cases, good in 24 cases and poor in 3 cases. The excellent and good rate was 92.11%. Conclusion The PFNA is an effective method for treatment of unstable intertrochanteric fracture with short operation time, less blood loss as well as acceptable complication related to implant in the elderly patients.