经皮股骨近端交锁髓内针内固定治疗老年股骨转子间骨折(附180例报道)  

Percutaneous proximal femoral nail internal fixation for treatment of intertrochanteric fractures in the elderly with a report of 180 cases

作　　者：石伟[1] 苗旭漫[1] 刘绍臣[1] 林延军[1] 

机构地区：[1]解放军第208医院全军骨科中心,长春市130062

出　　处：《中国矫形外科杂志》2010年第2期98-101,共4页Orthopedic Journal of China

摘　　要：[目的]探讨股骨近端交锁髓内针经皮穿针内固定治疗老年股骨转子问骨折的临床疗效。[方法]从2004年1月～2009年5月共对180例老年股骨转子阅骨折患者（180髋）行股经皮骨近端交锁髓内针内周定术。其中粥80例，女98例，平均76岁（57—99岁），按Evans分型标准：Ⅰ型12例，Ⅱ型28例，Ⅲa型62例，Ⅲ型20例，Ⅳ型49例，Ⅴ型9例。手术过程中使用骨科牵引床闭合复位，C型臂X线影像增强器透视满意后，经皮股骨近端交锁髓内针Ⅲ定骨折。[结果]80例患者中172例平均随访13．5个月（8～21个月），8例出院后失访。随访者中66例于术后6～8周复查X线片见断端骨痂生长，伤侧髋关节活动范围达到伤前水平，术后8川肝始扶拐部分功能练习，麒它6例m于过早负亘导致股骨颈螺钉切割豁出股骨头。本组患者骨折临床愈合时间为12～16周，愈合率98．8％，功能评定优良率为87．8％（151／172）。[结论]经皮股骨近端交锁髓内针内固定治疗老年股骨转子间骨折，具有操作简便、微创、放射线暴露时间短、并发症少、固定确实、骨折愈合快、功能恢复好等优点，是治疗老年股骨转子间骨折理想的方法。[Objective] To analyze the clinical effect af intertroehanteric fractures treated with pereutaneous proximal femoral nails （PFN）.[ Method] From January 2004 to May 2009,PFN using percutaneous technique was performed in 180 elderly patients of femoral intertrochanteric fractures （ 180 hips,80 males and 98 females） , with mean age of 76 years （ range from 57 -99 years）. According to Evans classification,12 cases were type I ,28 were type I/ ,62 were ma,20 were 11Ib,49 were IV ,9 were V. Traction table and C-ann fluroscopic intensifier were used with close reduction and interlocking during the course of operation. [ Result]One hundred and seventy two cases in 180 patients were followed up for 8 to 21 months with a mean of 13.5 months. Other 8 patients were lost to follow up after discharge. Of 172 patients followed up, 166 cases＇radiographs showed the callus during 6 -8 weeks postoperatively,while they had a full range of hip motion as the original level. Partial weight bearing exercises were carried out since the 8^th postoperative week. The time of clinical fracture healing was from 12 to 16 weeks, the rate of healing was 98.8%. In the function assessment of 172 patients the satisfactory rate reached to 87.8 percents. [ Conclusion ] Percutaneous proximal tbmoral nails is an ideal way for the treatment of intertrochanteric fractures in aged because of its simple procedure, minimal invasion,less fluoroseopy exposures, less complications, stable fixation, early fracture healing and satisfied functional outcomes.

关 键 词：股骨 转子间骨折 股骨近端交锁髓内针 经皮内固定术 老年人 

分 类 号：R687.3[医药卫生—骨科学]