股骨近端防旋髓内钉治疗老年股骨转子间骨折疗效及并发症探讨  

Effect and complications of proximal femoral anti-rotation intramedullary nail in the treatment of femoral intertrochanteric fracture in the elderly

作　　者：史文骥[1] 毛宾尧[1] 赵艳 SHI Wen-ji;MAO Bin-yao;ZHAO Yan(Department of Orthopaedics,the First Hospital of Ningbo,Ningbo 315010,Zhejiang,China)

机构地区：[1]宁波市第一医院浙江大学宁波医院骨科,浙江宁波315010 [2]宁波市第一医院神经外科,浙江宁波315010

出　　处：《中国骨伤》2021年第10期906-910,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)治疗老年股骨转子间骨折的疗效及并发症。方法:自2016年1月至2019年11月采用PFNA治疗老年股骨转子间骨折127例,男51例,女76例,年龄60~98(81.39±8.16)岁。根据Evans分型:Ⅰa型10例,Ⅰb型46例,Ⅰc型48例,Ⅰd型16例,Ⅱ型7例。AO/OTA分型:31-A1.2型10例,31-A1.3型84例,31-A 2.2型17例,31-A2.3型9例,31-A3型7例。观察术后并发症,术前及末次随访采用Harris评分评价关节功能。结果:所有患者完成PFNA手术,无一例切口感染。4例内固定失败,其中3例行人工股骨头置换;5例术后1年内死亡。2例肺动脉分支多发栓塞,抗凝治疗后愈;并发肺炎48例,其中9例术前存在肺部炎症;胸腔积液27例;急性心力衰竭3例;急性肾功能不全3例;除1例因肺炎,胸腔积液,低蛋白血症,呼吸衰竭住院期间死亡,其余治疗后症状控制或消失。119例患者获得随访,时间6~36(17.01±6.03)个月,髋关节Harris评分从术前8.96±5.40提高至末次随访83.57±8.92(t=75.86,P<0.01)。结论:PFNA治疗老年股骨转子间骨折可获得较满意的临床效果,但也可出现较多并发症,尤其要防治肺栓塞,及时纠正低血红蛋白及低蛋白血症,减少并发症。Objective:To study the prognosis and complications of proximal femoral nail antirotation(PFNA)in the treatment of elderly intertrochanteric fracture.Methods:From January 2016 to November 2019,127 cases of femoral intertrochanteric fracture were treated with PFNA,including 51 males and 76 females.The average age was 81.39±8.16(range from 60 to 98).According to Evans classification,the numbers of cases of typeⅠa,typeⅠb,typeⅠc,typeⅠd and typeⅡwere 10,46,48,16 and 7,respectively.Based on the AO/OTA classification,there were 10 cases of type 31-A1.2,84 of type 31-A1.3,17 of type 31-A2.2,9 of type 31-A2.3,and 7 of type 31-A3.Preoperative and the final follow-up,function of hip joint of patients treated with the PFNA were evaluated by harris hip score,and the postoperative complications were observed.Results:No incision infection occurred in all patients after PFNA.In this research,4 cases failed in internal fixation,three of them underwent artificial femoral head replacement;5 cases died within one year after operation;2 cases had multiple embolizations of pulmonary artery branches,which recovered after anticoagulation treatment.There were 48 cases complicated with pneumonia,among which 9 cases had pulmonary inflammation before operation;27 cases with pleural effusion,3 cases with acute heart failure,3 cases with acute renal insufficiency,except one case died of pneumonia,pleural effusion,hypoproteinemia and respiratory failure during hospitalization,the other patients recovered after treatment.All 119 patients were followed up for 6 to 36 months,with an average of(17.01±6.03)months,Harris hip score increased from 8.96±5.40 preoperation to 83.57±8.92 at the final follow-up(t=75.86,P<0.01).Conclusion:PFNA is a recommended option for the treatment of senile patients with intertrochanteric fracture.However,there were a lot of complications when femoral intertrochanteric fractures happened in aged patients,especially prevention and treatment of pulmonary embolism,promptly corrected low hemoglobin and low albu

关 键 词：股骨转子间骨折 骨折固定术 髓内 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]