老年股骨转子间骨折PFNA内固定失败的再手术策略  

Strategy of reoperation for PFNA internal fixation failure in the treatment of senile femoral intertrochanteric fracture

作　　者：蒲志超[1] 黄坤炳[1] 薛剑[1] 谢伟勇[1] 李献成 PU Zhichao;HUANG Kunbing;XUE Jian;XIE Weiyong;LI Xiancheng(Department of Orthopedics,Armed Police Force Guangdong Provincial Corps Hospital,Guangzhou,Guangdong 510507,China)

机构地区：[1]武警广东省总队医院骨科,广州510507

出　　处：《中国骨科临床与基础研究杂志》2020年第1期16-21,共6页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：广东省医学科学技术研究基金(201811623492670)。

摘　　要：目的探讨老年股骨转子间骨折股骨近端防旋髓内钉(PFNA)内固定失败的再手术策略。方法回顾性分析2014年10月至2019年1月武警广东省总队医院收治的17例老年股骨转子间骨折PFNA内固定失败患者的临床资料,其中男7例,女10例,平均年龄(73.0±5.2)岁。11例行全髋关节置换术,6例行人工双极股骨头置换术。术后随访期间拍摄骨盆正位、患侧股骨全长正侧位X线片,观察假体初始固定及生存情况,记录手术前后Harris髋关节评分。结果随访时间12~25个月,平均随访时间(16.8±4.7)个月,随访期间复查X线片,未见假体松动、下沉、脱位、假体周围骨折并发症。术后1年髋关节Harris评分为(80.5±26.7)分,与术前(23.0±8.2)分比较,差异具有统计学意义(P<0.05)。结论应用全髋关节置换术或人工双极股骨头置换术治疗老年股骨转子间骨折PFNA内固定失败患者,可促进髋关节功能恢复,减少卧床并发症,允许患者早期下床活动,短期疗效满意。Objective To investigate the strategy of reoperation for internal fixation failure of proximal femoral nail antirotation(PFNA)in the treatment of senile patients with femoral intertrochanteric fracture(FIF).Methods Retrospective analysis of clinical data of 17 elderly FIF patients,who suffered from PFNA internal fixation failure in Armed Police Force Guangdong Provincial Corps Hospital from October 2014 to January 2019 was conducted.Among the patients,there were 7 males and 10 females,with an average age of(73.0±5.2)years old.Eleven patients underwent total hip arthroplasty(THA),and six patients underwent artificial bipolar femoral head(ABFH)replacement.During the follow-up,pelvic anteroposterior radiographs as well as the full-length anterolateral X-ray of the affected femur were taken to observe the initial fixation and the survival of the prosthesis,Harris hip scores before and after the operation were also recorded.Results The follow-up time ranged from 12 to 25 months,with an average follow-up time of(16.8±4.7)months.X-ray films showed no complications such as prosthesis loosening,subsidence,dislocation,and periprosthetic fractures.At 1 year postoperatively,Harris score was(80.5±26.7),which showed statistical difference when compared with preoperative one,(23.0±8.2).Conclusion For elderly FIF patients with PFNA internal fixation failure,the use of THA or ABFH replacement can promote hip function recovery,reduce bedridden complications,enable patients to ambulate early and obtain satisfactory short-term efficacy.

关 键 词：股骨颈骨折 骨折固定术 髓内 骨钉 治疗失败 再手术 关节成形术 置换 髋 老年人 

分 类 号：R683.421[医药卫生—骨科学] R687.33[医药卫生—外科学]