防旋股骨近端髓内钉微创治疗老年患者股骨转子间骨折25例报告

目的探讨防旋股骨近端髓内钉（proximal femoral nail antirotation,PFNA）微创治疗老年患者股骨转子间骨折的临床疗效。方法2007年2月-2008年6月,采用PFNA治疗老年股骨转子间骨折25例,按照Tronzo-Evans分型：Ⅰ型2例,Ⅱ型2例,Ⅲ型16例,Ⅳ型5例,闭合复位,小切口置入PFNA。结果手术时间30-70 min,平均50.3 min。术中出血量70-200 ml,平均100.2 ml。25例随访3-12个月,平均7.1月,骨折全部愈合,愈合时间10-14周,平均11周,未出现髋内翻,内固定物松动及切割现象;按Harris髋关节功能评分标准：优20例,良4例,中1例。结论PFNA具有微创,操作简单,手术时间短,出血量少,固定牢靠,愈合率高等特点,尤其适用于老年骨质疏松患者,是治疗老年股骨转子间骨折较为理想的内固定材料。

Proximal Femoral Nail Anti-rotation for Femoral Intertrochanteric Fractures in 25 Aged Patients

Objective To explore the clinical results of minimally invasive therapy for femoral intertrochanteric fractures with proximal femoral nail anti-rotation （PFNA） in 25 elderly patients. Methods A total of 25 patients with intertrochanteric fractures were treated by PFNA in our hospital from February 2007 to June 2008. The patients received close reduction and minimal invasive operation. Based upon the Tronzo-Evans classification, type Ⅰ fractures were diagnosed in 2 cases, type Ⅱ fractures in 2 cases, type Ⅲ in 16, and type Ⅳ in 5. Results The mean operation time in this series was 50. 3 min （30 - 70 min）, an the mean intraoperative blood loss was 100.2 ml （70 -200 ml）. All the 25 patients completed a follow-up of 3 to 12 months （average time 7.1 months） , during which all the fractures healed in 10 to 14 weeks with a mean of 11 weeks, without occurrence of varus deformity, hardware loosening or hardware cutting. According to the Harris Hip Score, 20 cases achieved excellent results, 4 were good, and 1 was fair. Conclusions It is a reliable and ideal method to treat intertrochanteric fractures with PFNA in elderly patients, for the procedure is convenient and minimally invasive, resulting in firm fixation, less blood loss, short operation time, and high healing rate.