防旋股骨近端髓内钉在老年股骨粗隆间骨折的应用  

Application of proximal femoral nail anti-roation in femoral intertrochanteric fractures of elderly patients

作　　者：徐掭发 詹科 谢燕花 胡俊勇[1] 刘建华[1] Xu Tianfa;Zhan Ke;Xie Yanhua;Hu Junyong;Liu Jianhua(Department of Jiont Surgery, the Eastern Hospital of the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510700, China;The Peoples Hospital of Shenzhen, Shenzhen 518000, China)

机构地区：[1]中山大学附属第一医院东院骨科,广州510700 [2]深圳市人民医院脊柱外科,518000

出　　处：《中华关节外科杂志（电子版）》2021年第1期7-11,共5页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的观察老年患者(≥80岁)股骨转子间骨折防旋股骨近端髓内钉(PFNA)的治疗效果,并与非老年患者(<80岁)比较疗效,分析和探讨PFNA在老年患者中应用的有效性和安全性。方法回顾性分析2011年1月1日至2014年12月31日股骨转子间骨折共186例收入中山大学附属第一医院东院骨科并行PFNA治疗的患者的病史资料,其中排除8例合并严重心肺功能不全及手术依从性差等。80岁及以上为老年组,80岁以下为非老年组,收集两组术前、术中、术后的手术时间、术中失血量、术后并发症及术后疗效等多项相关指标并予以t检验和方差分析等统计学分析。结果老年组患者手术时间及术中出血量均高于非老年组,差异具有统计学意义(t=4.7、2.6,均为P<0.05);手术切口长度及住院天数两组差异没有统计学意义(t=-1.9、1.2,均为P>0.05)。两组患者术后各期髋关节Harris评分,差异无统计学意义(F=2.0,P>0.05)。两组随访优良率差异无统计学意义(Z=1.8,P>0.05)。结论尽管老年患者手术风险高、并发症多,但是通过加强护理、控制手术风险、降低患者术后并发症发生率,在保证患者安全的基础上,PFNA治疗老年患者股骨转子间骨折可以获得满意的疗效。Objective To observe and analysis the safety and therapeutic effect of proximal femornal nail antirotion(PFNA)in geriatric patients(≥80 years)with femoral intertrochanteric fracturecomparing with young patients(<80 years).Methods From January 1st 2012 to December 31st 2014,186 of geriatric and young patients with femoral intertrochanteric fractures who underwent PFNA in the Eastern Hospital of the First Affiliated Hospital,Sun Yat-sen University,were retrospectively analyzed.Among the cases,eight cases with severe cardiopulmonary insufficiency and poor surgical compliance were excluded.The patients were divided into the geriatric group and the young group according to the different ages(80 years as the demarcation).The operation time,intraoperative blood loss,postoperative complications and curative effect for all the preoperative,intraoperative and postoperative data of the two groups were analyzed by t test and analysis of variance.Results The young group presented shorter operation time,less blood loss,compared with the geriatric patient group(t=4.7,2.6,both P<0.05).There was no statistically difference in length of incision and hospital stays between the two groups(t=-1.9,1.2,both P>0.05).There was no statistically significant difference in Harris scores between the two groups in different periods after operation(F=2.0,P>0.05).Superior rates of functional recovery were almost the same in the follow-up visit(Z=1.8,P>0.05).Conclusion Although geriatric patients have higher operation and complication risks compared to young patients,PFNA is effective for the treatment of femoral intertrochanteric fractures in geriatric patients,when providing intensive care,pre-and post-operative risk control to insure the safty.

关 键 词：老年 股骨骨折 骨折固定 髓内 

分 类 号：R68[医药卫生—骨科学]