骨水泥强化型股骨近端防旋髓内钉固定治疗严重骨质疏松性股骨转子间骨折  

Bone cement-enhanced proximal femoral nail antirotation for treatment of severe osteoporotic intertrochanteric fracture

作　　者：陈宏峰[1] 杨冬松[1] 凌建生 陈鹏[1] 李真[1] 王鹏儒 吴广良[1] 俞光荣[2] Chen Hongfeng;Yang Dongsong;Ling Jiansheng;Chen Peng;Li Zhen;Wang Pengru;Wu Guang liang;Yu Guangrong(Department of Orthopaedics,The Second Affiliated Hospital to Luohe Medical College,Luohe,Henan 462300,China;Department of Orthopaedics,Tongji Hospital,Tongji University,Shanghai 200333,China)

机构地区：[1]漯河医学高等专科学校第二附属医院骨科,462300 [2]同济大学附属同济医院骨科,上海200333

出　　处：《中华创伤骨科杂志》2020年第3期259-262,共4页Chinese Journal of Orthopaedic Trauma

基　　金：河南科技攻关项目(172102310659)。

摘　　要：目的探讨骨水泥强化型股骨近端防旋髓内钉(PFNA)固定治疗严重骨质疏松性股骨转子间骨折的临床效果。方法回顾性分析2016年1月至2017年6月期间漯河医学高等专科学校第二附属医院骨科收治的23例严重骨质疏松性股骨转子间骨折患者资料。男9例,女14例;年龄为80~91岁,平均85.3岁。骨折AO/OTA-2018版分型:31-A1.3型2例,31-A2.2型5例,31-A2.3型13例,31-A3.3型3例。骨质疏松按Singh标准分级:1级4例,2级16例,3级3例。所有患者均采用骨水泥强化型PFNA固定。记录患者的手术时间、术中出血量、并发症发生情况、骨折愈合时间及末次随访时髋关节Harris评分等。结果本组患者的手术时间平均为56.3 min(47~91 min),术中出血量平均为197 mL(110~450 mL)。23例患者术后获平均14.7个月(5~27个月)随访。1例患者于术后5个月因急性化脓性梗阻性胆管炎而死亡,该患者死亡前根据髋关节Harris评分标准评定疗效为良。23例患者术后骨折均获骨性愈合,愈合时间平均为11.3周(8~18周)。末次随访时根据髋关节Harris评分标准评定疗效:优11例,良10例,可2例,优良率为91.3%。随访期间无一例患者发生骨折不愈合、股骨头缺血性坏死及髓内钉断裂等并发症。结论骨水泥强化型PFNA固定治疗严重骨质疏松性股骨转子间骨折,可提高螺钉把持力,降低内固定物失效风险,近期疗效良好。Objective To observe the effectiveness of bone cement-enhanced proximal femoral nail antirotation(PFNA)in the treatment of severe osteoporotic intertrochanteric fracture.Methods Between January 2016 and June 2017,23 patients with severe osteoporotic intertrochanteric fracture were treated with bone cement-enhanced PFNA at Department of Orthopaedics,The Second Affiliated Hospital to Luohe Medical College.They were 9 men and 14 women with an average age of 85.3 years(range,from 80 to 91 years).According to AO/OTA-2018 classification,there were 2 cases of type 31-A1.3,5 cases of type 31-A2.2,13 cases of type 31-A2.3 and 3 cases of type 31-A3.3.According to Singh standard grading,4 cases were rated as level 1,16 cases as level 2 and 3 cases as level 3.The PFNA fixation was enhanced by bone cement in all.The operation time,amount of intraoperative bleeding,postoperative complications,fracture healing time and hip Harris scores at the last follow-up were recorded.Results The operation time averaged 56.3 minutes(range,from 47 to 91 minutes)and the amount of intraoperative bleeding 197 mL(range,from 110 to 450 mL).All patients were followed up for 5 to 27 months(mean,14.7 months).One patient who had been rated as good by the Harris hip score died 5 months after surgery because of acute suppurative obstructive cholangitis.All the 23 fractures achieved bony union.The healing time averaged 11.3 weeks(range,from 8 to 18 weeks).By the Harris scores at the last follow-up,11 cases were excellent,10 cases good and 2 cases fair,giving an excellent and good rate of 91.3%.Conclusion Bone cement-enhanced PFNA can bring about good short-term outcomes for severe osteoporotic intertrochanteric fractures because it can improve the screw control and reduce the risk of internal fixation failure.

关 键 词：髋骨折 骨折固定术 髓内 骨钉 骨质疏松 骨水泥 

分 类 号：R687[医药卫生—骨科学]