中国医学创新
中國醫學創新
중국의학창신
MEDICAL INNOVATION OF CHINA
2014年
26期
13-15,16
,共4页
股骨骨折%骨折内固定术%骨质疏松症%股骨近端髓内钉
股骨骨摺%骨摺內固定術%骨質疏鬆癥%股骨近耑髓內釘
고골골절%골절내고정술%골질소송증%고골근단수내정
Femoral fracture%Internal fixation of fracture%Osteoporosis%Proximal femoral nail
目的：探讨防旋转股骨近端髓内钉（proximal femoral nail antirotation，PFNA）治疗老年股骨粗隆间不稳定型骨折的特点、手术方法及初期疗效。方法：选取2008年3月-2012年12月采用PFNA治疗的26例老年股骨粗隆间骨折患者，其中男11例，女15例；年龄65~97岁，平均78.2岁；按照AO分类，A2型16例， A3型10例，患者入院后17例采用皮肤牵引，9例采用骨骼牵引，入院后2~4 d实施手术，术中均经骨科下肢牵引床牵引手法复位，小切口置入PFNA，术中不暴露骨折端。结果：本组26例患者平均手术时间55 min （40~110 min），平均出血量80 mL（30~200 mL），术后1例因为肺部感染转入内科治疗，合并下肢深静脉血栓患者2例，其余患者康复出院。随访5~48个月，平均20个月，部分负重行走时间2周，完全负重行走时间4周，骨折愈合时间10周。患者均无切口感染、深静脉血栓、内固定松动、髋内翻等并发症。根据Harris髋关节功能评分：优18例，良4例，一般2例，差1例，优良率为84.6%。结论：PFNA结合牵引床治疗老年股骨粗隆间不稳定型骨折具有创伤小、手术操作简单、并发症少、内固定牢固等优势，值得临床推广应用。
目的：探討防鏇轉股骨近耑髓內釘（proximal femoral nail antirotation，PFNA）治療老年股骨粗隆間不穩定型骨摺的特點、手術方法及初期療效。方法：選取2008年3月-2012年12月採用PFNA治療的26例老年股骨粗隆間骨摺患者，其中男11例，女15例；年齡65~97歲，平均78.2歲；按照AO分類，A2型16例， A3型10例，患者入院後17例採用皮膚牽引，9例採用骨骼牽引，入院後2~4 d實施手術，術中均經骨科下肢牽引床牽引手法複位，小切口置入PFNA，術中不暴露骨摺耑。結果：本組26例患者平均手術時間55 min （40~110 min），平均齣血量80 mL（30~200 mL），術後1例因為肺部感染轉入內科治療，閤併下肢深靜脈血栓患者2例，其餘患者康複齣院。隨訪5~48箇月，平均20箇月，部分負重行走時間2週，完全負重行走時間4週，骨摺愈閤時間10週。患者均無切口感染、深靜脈血栓、內固定鬆動、髖內翻等併髮癥。根據Harris髖關節功能評分：優18例，良4例，一般2例，差1例，優良率為84.6%。結論：PFNA結閤牽引床治療老年股骨粗隆間不穩定型骨摺具有創傷小、手術操作簡單、併髮癥少、內固定牢固等優勢，值得臨床推廣應用。
목적：탐토방선전고골근단수내정（proximal femoral nail antirotation，PFNA）치료노년고골조륭간불은정형골절적특점、수술방법급초기료효。방법：선취2008년3월-2012년12월채용PFNA치료적26례노년고골조륭간골절환자，기중남11례，녀15례；년령65~97세，평균78.2세；안조AO분류，A2형16례， A3형10례，환자입원후17례채용피부견인，9례채용골격견인，입원후2~4 d실시수술，술중균경골과하지견인상견인수법복위，소절구치입PFNA，술중불폭로골절단。결과：본조26례환자평균수술시간55 min （40~110 min），평균출혈량80 mL（30~200 mL），술후1례인위폐부감염전입내과치료，합병하지심정맥혈전환자2례，기여환자강복출원。수방5~48개월，평균20개월，부분부중행주시간2주，완전부중행주시간4주，골절유합시간10주。환자균무절구감염、심정맥혈전、내고정송동、관내번등병발증。근거Harris관관절공능평분：우18례，량4례，일반2례，차1례，우량솔위84.6%。결론：PFNA결합견인상치료노년고골조륭간불은정형골절구유창상소、수술조작간단、병발증소、내고정뢰고등우세，치득림상추엄응용。
Objective:To investigate characteristics,surgical methods and initial efficacy of the anti-rotation type proximal nail(proximal femoral nail antirotation,PFNA)in treatment of elderly patients with unstable femoral intertrochanteric fracture.Method:26 elderly patients with unstable femoral intertrochanteric fracture who treated with PFNA from March 2008 to December 2012 were selected,11 cases were male,15 cases were female,65-97 years old, the mean age was 78.2 years.According to AO classification,A2 type was 16 case,A3 was 10 case.After admission,17 patients were treated with skin traction,9 patients were treated with skeletal traction.Patients underwent surgery after admission 2-4 d,underwent traction manipulation by lower limb traction bed of orthopaedics in the surgery,PFNA was placed into small incision,in surgery couldn’t be exposed fracture.Result:In 26 patients,the average operation time was 55 min(40-110 min),the average amount of bleeding was 80 mL(30-200 mL),1 patient transferred to medical treatment because of lung infection and 2 cases combined deep venous thrombosis(DVT),the remaining patients were discharged from the hospital.Followed up for 5-48 months,an average of 20 months,partial weight-bearing was 2 weeks,the full weight-bearing walking time was 4 weeks,fracture healing time was 10 weeks,patients were no incision infection,deep vein thrombosis,internal fixation loosening and hip varus complications.According to the Harris hip function score:excellent in 18 cases,good in 4 cases,general in 2 cases,poor in 1 case.the excellent and good rate was 84.6%.Conclusion:PFNA combined with traction bed treatment of unstable intertrochanteric femoral fractures has less trauma,simple operation,less complications,internal fixation and other advantages,is worthy of clinical application.
