股骨近端防旋髓内钉置入修复老年股骨转子间骨折  

Proximal femoral nail anti-rotation for intertrochanteric fracture in aged patients

作　　者：康宁[1] 杨自权[2] 张晨[1] 冯君宇 

机构地区：[1]山西医科大学,山西省太原市030001 [2]山西医科大学第二临床医院骨科,山西省太原市030001

出　　处：《中国组织工程研究》2015年第31期5000-5003,共4页Chinese Journal of Tissue Engineering Research

摘　　要：背景:虽然股骨近端防旋髓内钉具有良好的生物力学基础,在治疗老年股骨转子间骨折方面具有明显优势,但是临床上因材料匹配、手术细节等问题处理不当,仍然出现许多问题,影响治疗效果及功能恢复。目的:分析股骨近端防旋髓内钉治疗60岁以上老年股骨转子间骨折的效果及出现的问题。方法:自2011年7月至2012年7月采用股骨近端防旋髓内钉治疗老年股骨转子间骨折患者56例,建立临床资料库,对治疗过程中出现的问题及治疗后出现的并发症进行统一分析。治疗后1,3,6,9,12个月进行门诊及电话随访,评估治疗效果及髋关节功能恢复情况。结果与结论:4例患者治疗后1年内死亡,7例患者因其他原因1年内失访,其余45例患者随访时间12-24个月,平均随访18.2个月。Harris评分为(85.00±6.75)分,其中优26例,良15例,中3例,差1例,优良率为91%。治疗后骨折断端位置不满意18例,股骨近端防旋髓内钉与股骨近端不匹配9例,螺旋刀片位置及长度不满意7例,并发外侧皮质骨折7例;治疗后并发肺栓塞1例,心脑血管疾病1例,股骨近端局部肿胀9例,髋部疼痛13例,骨折延长愈合5例。结果可见股骨近端防旋髓内钉置入修复老年股骨转子间骨折效果较好,但是对骨折断端分离及减少治疗中、治疗后并发症的发生还有待改善。BACKGROUND：Proximal femoral nail anti-rotation has good biomechanical basis, and has obvious advantages for intertrochanteric fracture in aged patients, but there are some problems in the clinic, because of improper handling of material matching and operation details, which can impact therapeutic effects and functional recovery. OBJECTIVE：To analyze the efficacy and issues of proximal femoral nail anti-rotation in the treatment of intertrochanteric fracture in patients at more than 60 years old. METHODS：From July 2011 to July 2012, proximal femoral nail anti-rotation was used to treat 56 cases of intertrochanteric fractures. Clinical data bank was established to analyze intraopeative problems and postoperative complications. At 1, 3, 6, 9 and 12 months postoperatively, outpatient and telephone folow-up were carried out to evaluate therapeutic effects and functional recovery of hip joint. RESULTS AND CONCLUSION：Four patients died within 1 year. Seven patients lost within a year for other reasons. The remaining 45 patients were folowed with the time from 12 to 24 months, with an average time of 18.2 months. Harris score was （85.00±6.75） points. There were excelent in 26 cases, good in 15 cases, average in 3 cases and poor in 1 case, with an excelent and good rate of 91%. 18 cases were not satisfied with the position of fracture fragments. In 9 cases, proximal femur was not match with the proximal femoral nail anti-rotation. Seven cases were not satisfied because of the location and length of the spiral blade. Seven cases affected lateral cortex fracture. One case experienced postoperative pulmonary embolism. One case suffered from cardiovascular and cerebrovascular diseases. Nine cases suffered from local sweling. 13 casesnbsp;experienced hip pain. Five cases affected the healing of fracture extended. Results showed that proximal femoral nail anti-rotation for intertrochanteric fracture in aged patients obtained good outcomes, but we should improve the separation of fracture fragments and reduce intrao

关 键 词：植入物 骨植入物 股骨近端防旋髓内钉 转子间骨折 老年 髋关节功能 并发症 

分 类 号：R318[医药卫生—生物医学工程]