股骨近端防旋髓内固定治疗高龄股骨转子周围骨折  

Management of unstable trochanteric fractures with intramedullary fixation in elderly patients

作　　者：熊进[1] 施鸿飞[1] 王骏飞[1] 陈一心[1] 

机构地区：[1]南京大学医学院附属鼓楼医院骨科,江苏南京210008

出　　处：《临床骨科杂志》2011年第6期681-683,共3页Journal of Clinical Orthopaedics

基　　金：中央高校基本科研业务费专项资金(编号:021414340029);南京市卫生局青年启动项目(编号:YKK10063)

摘　　要：目的探讨应用股骨近端防旋髓内固定(PFNA或Gamma3)治疗高龄股骨转子周围骨折的疗效。方法对65例高龄股骨转子周围骨折患者经详细术前评估后,在透视下行骨折闭合复位,采用PFNA或Gamma3行内固定。术后第2天开始功能锻炼。随访时对骨折复位情况、内固定效果、髋关节功能及并发症等进行分析。结果 65例患者术中、术后复位效果评估:PFNA组优12例,良5例,差4例,优良率81%;Gamma3组优25例,良11例,差8例,优良率81.8%。51例获得完整随访,时间6～12个月,术后24周时HSS评分为58～85(63.5±16.5)分。Gamma3组术后发生深静脉血栓2例,PFNA组发生深部感染1例,均经治疗后痊愈;术后4周内PFNA组2例发生螺旋刀片股骨头内切出,二次取出内固定;无神经损伤及骨不愈合等发生。结论对高龄股骨转子周围骨折患者采用PFNA或Gamma3髓内固定治疗均可获得较好的临床疗效。Objective To investigate the strategies and outcomes of surgical management and postoperative rehabilitation with the application of intramedullary nail(PFNA/Gamma3) on trochanteric fractures in elderly patients.Methods Sixty-five consecutive elderly patients with unstable trochanteric fractures receiving surgical treatment were retrospectively reviewed.With careful evaluation and pre-operation planning,all patients were treated with close reduction under C-arm X-ray and intramedullary nail(PFNA/Gamma3) fixation.After surgical treatment,all the cases were treated early postoperative rehabilitations.The outcomes including the results of reduction and fixation,the hip function,the rate of implant failure were assessed.Results In twenty-one patients treated with PFNA,the reduction outcome was excellent in 12,good in 5 and poor in 4 cases,and the excellent and good rate was 81%.For patients implanted with Gamma 3,the reduction outcome was classified as excellent in 25 cases,good in 11 and poor in 8,and the excellent and good rate was 81.8%.Fifty-one patients were followed up for 6~12 months.The mean HSS score was 63.5±16.5(58~85) at twenty-four weeks after surgery.The postoperative complications included deep vein thrombosis in two cases with Gamma3 group and deep infection in one case with PFNA group which recovered after treatment and care.In addition,two additional cases showed helical blade cut out at four weeks after operation.The implants were removed and bony fusion was achieved in both patients.There was no neurological complication and non-union in these cases.Conclusions Intramedullary nail(PFNA/Gamma3) can provide sufficient biomechanical stability for unstable trochanteric fractures in elderly patients and lead to good clinical outcome.

关 键 词：股骨转子骨折 髓内钉 骨质疏松 老年人 

分 类 号：R68[医药卫生—骨科学]