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PFNA治疗老年外侧壁不完整型股骨转子间骨折的疗效分析

杨国跃1,江汉2,3,韩立强2,江毅1,贾健4   

  1. 1. 天津市第三中心医院
    2. 天津市第三中心医院骨科
    3.
    4. 天津市天津医院创伤科
  • 收稿日期:2013-05-06 修回日期:2013-12-09 出版日期:2014-07-15 发布日期:2014-07-15
  • 通讯作者: 贾健

FNA Therapy for Intertrochanteric Fracture of Incomplete Lateral Wall Type in the Elderly

  • Received:2013-05-06 Revised:2013-12-09 Published:2014-07-15 Online:2014-07-15

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摘要：

【摘要】目的 探讨股骨近端髓内钉-螺旋刀片(PFNA)治疗老年外侧壁不完整型股骨转子间骨折的初期疗效。方法采用PFNA内固定治疗股骨外侧壁不完整型股骨转子间骨折25例。按照骨折AO分类标准A2型8例，A3 型17例，所有患者均行三维CT检查，其中A2型有6例存在股骨近端外侧壁骨折，2例A2型在行动力髋螺钉（DHS）术中出现医源性股骨外侧壁骨折中转为PFNA内固定。其他患者均采用闭合复位PFNA内固定治疗。结果25例骨折均顺利愈合，平均愈合时间为11周。其中1例再次摔倒致股骨髓内钉远端骨折，换加长型PFNA，术后14周转子间骨折与股骨干骨折均愈合。本组25例中，1例因脑出血死亡；2例因存在膝关节骨性关节炎，需要助行器辅助行走；3 例出现患肢小腿肌间静脉血栓；其余患者均无感染、骨不连及内固定失效等并发症发生。根据Harris功能评分：优14 例，良8例，可2例，差1例，优良率为88%。结论PFNA治疗老年外侧壁不完整型股骨转子间骨折固定可靠，允许早期功能锻炼，初期疗效良好。

关键词: 髋骨折, 股骨外侧壁, 骨折固定术, 内, 治疗结果

Abstract:

 [Abstract] Objective To explore the initial effects of the treatment of proximal femoral nail-helical blade (PFNA) in elderly patients with intertrochanteric fracture of the incomplete lateral wall type. Methods A total of25patients were enrolled in this study including8cases of type A2, 17cases of type A3according to AO classification. All patients under? went three-dimensional CT scan. In all patients with type A2fracture, there were 6cases with coronal plane fracture on the greater trochanter, and PFNA was used instead of DHS when an iatrogenic fracture occurred in2patients. All other patients were treated with closed reduction and fixed with PFNA.Results All patients healed and the average healing time was11 weeks, one patient fell down once again and the fracture occurred on the shaft, when a long PFNA was used, both of the frac? tures healed 14weeks after surgery. In all of the25patients,1patient died due to cerebral hemorrhage13months after sur? gery;2patients needed walking aids due to the presence of osteoarthritis of the knee and calf muscular venous thrombosis was diagnosed in3cases. No complications were found in the other patients, such as infection, nonunion and fixation failure. According to the Harris hip score system, there were14cases of“excellent”，8cases of“good”，2cases of“fair”and1pa? tient of“poor”．Conclusion The PFNA treatment can provide a good fixation for intertrochanteric fractures of incomplete lateral wall type, which allow patients to do exercise early and achieve an excellent initial outcome.

Key words: hip fracture, femor lateral wall, fracture fixation, internal, treatment outcome