Sun Fang-Gui, Wang De-Xin, Hu Yu-Tong, Xu Rong-Ming
The Orthopaedic Centre, Mingzhou Hospital of Zhejiang University, Ningbo 315000, Zhejiang, China.
Zhongguo Gu Shang. 2017 Oct 25;30(10):915-919. doi: 10.3969/j.issn.1003-0034.2017.10.008.
To explore the curative effect and the recessive loss of blooding of PFNA for the treatment of intertrochanteric fractures of femur.
From January 2012 to January 2015, a total of 49 patients with intertrochanteric fractures of femur were treated with proximal femoral anti-rotation nail including 41 males and 8 females with an average age of 79 years old ranging from 65 to 91 years old. According to the modified Evans type, 1 case was type I, 12 cases were type II, 36 cases were type III. All cases were fresh fractures. Patients had hip pain, movement limited, joint swelling, bruising, extorsion deformity, X-ray and CT examination showed completely fractures. All patients were treated by closed reduction and PFNA internal fixation. Three comminuted fractures using closed reduction were not satisfied, then were treated by limited PFNA fixation after open reduction.
The patients' incision got the grade A healing, no complications such as infection and internal fixation failure happened. All patients were followed up from 6 to 36 months (means 22 months). The pain VAS score decreased from preoperative 7.70±1.97 to 1.00±0.26 at 6 months after operation(<0.01). Harris hip score improved from preoperative 8.70±4.19 to 91.70±5.31 at 6 months after operation(<0.01). The outcome at 6 months after operation was excellent in 34 cases, good in 7, poor in 1. The fracture healing time was from 8 to 16 weeks with an average of 12 weeks after operation. One patient with osteoporosis, crushing broken, poor compliance, associated with schizophrenia at the same time, appeared with the displacement of the femoral greater trochanter, with conservative treatment for healing.
Intertrochanteric fractures of femur are common in the elderly trauma, in pain relief, recovery of hip function, to provide quality of life for the patients, PFNA achieved satisfactory effect, but its existence is worth to pay close attention to the recessive loss of blood.
探讨股骨近端防旋髓内钉（PFNA）治疗股骨粗隆间骨折的疗效及隐性失血情况。
选取2012年1月至2015年1月期间采用股骨近端防旋髓内钉治疗的49例股骨粗隆间骨折患者，其中男性41例，女性8例，平均年龄79岁，年龄范围65至91岁。根据改良Evans分型，I型1例，II型12例，III型36例。所有病例均为新鲜骨折。患者均有髋部疼痛、活动受限、关节肿胀、瘀斑、外旋畸形，经X线及CT检查显示为完全骨折。所有患者均采用闭合复位PFNA内固定治疗。3例粉碎性骨折采用闭合复位效果不满意，改行切开复位有限PFNA固定。
患者切口均甲级愈合，未发生感染、内固定失败等并发症。所有患者均获随访，随访时间6至36个月（平均22个月）。术后6个月疼痛视觉模拟评分（VAS）由术前的7.70±1.97降至1.00±0.26（<0.01）。术后6个月Harris髋关节评分由术前的8.70±4.19提高至91.70±5.31（<0.01）。术后6个月疗效评价：优34例，良7例，差1例。骨折愈合时间为术后8至16周，平均12周。1例骨质疏松、粉碎骨折、依从性差且同时患有精神分裂症的患者出现股骨大转子移位，经保守治疗愈合。
股骨粗隆间骨折是老年创伤中的常见疾病，在缓解疼痛、恢复髋关节功能、提高患者生活质量方面，PFNA取得了满意疗效，但应重视其隐性失血问题。
