Objective To investigate the clinical efficacy of Asian proximal femur intramedullary nail antirotation (PFNA-Ⅱ) in the treatment of intertrochanteric fractures in elderly people.Methods From July 2009 to December 2011,127 elderly patients with intertrochanteric fracture were treated by PFNA-Ⅱ.They were 49 cases of male and 78 cases of female,with a mean age of (74.3±15) years.127 elderly patients were classified by modified Evans:type Ⅰ (n=37),typeⅡ (n=42),type Ⅲ (n=26),type Ⅳ (n=15),type V (n=7).We made the statistics on the intraoperative bleeding volume,operation time,incision length,X-light exposure times,and made evaluation of the efficacy of postoperative follow-up and complications by the Harris hip score.Results The average operation time was 42.5 min (35-90) min,the average intraoperative bleeding volume was 107.5 ml (65-410)ml,X-light exposure times were (2.5±1.4) times (2-4) times and the average total incision length was (6.5± 1.8) cm (5.5-11.0) cm.No serious complications or original complications were found during perioperative period.All patients received a 6 to 24 month follow-up (mean 12.5 months in average).The X ray examination showed that the average neck shaft angle was (134±13)° (120°-150°).The average fracture healing time was (14.0±2.5) weeks (11 to 19 weeks).The average hip Harris score was (86.5± 19.5) points (65-100 points).Among them,29 cases (22.83％) were excellent,76 cases (59.8％) were good,20 cases (15.7％) were moderate,2 cases (1.6％) were poor.Totally,excellent and good rate was 82.7％.No complications including hip varus deformity,screw cut-out and femoral shaft fractures were found.There were 14 patients (11.0％) with thigh pain and 5 patients (3.9％) with inner thigh pain.The heavier pain in 4 patients were improved by physical therapy.Conclusions Asian PFNA-Ⅱ has advantages including simple operation,fewer complications,and better clinical efficacy for the treatment of intertrochanteric fractures,but its longterm efficacy and complications still need a large sample and multi-center observation.%目的 探讨亚洲型股骨近端防旋髓内钉(PFNA-Ⅱ)治疗老年股骨粗隆间骨折的临床疗效. 方法 2009年7月至2011年12月,应用亚洲型股骨近端PFNA-Ⅱ治疗127例老年股骨粗隆间骨折患者.对术中出血量、手术时间、切口总长度、C壁透照次数进行统计,采用Harris评分对术后随访的疗效、并发症进行评价. 结果 手术时间为35～90 min,平均42.5 min,失血量为65～410ml,平均107.5ml,C壁透视2～4次,平均(2.5士1.4)次；切口总长度5.5～11.0 cm,平均(6.5±1.8) cm.围术期无严重并发症或原有合并症加重,患者术后随访6～24个月,平均12.5个月,复查X片示颈干角120°～150°,平均(134±13)°,骨折临床愈合时间11～19周,平均(14.0±2.5)周,术后半年患髋Harris评分为65～100分,平均(86.5±19.5)分,其中优29例(22.8％),良76例(59.8％),中20例(15.7％),差2例(1.6％),优良率达82.7％.无髋内翻、内置物切出及周围骨折等并发症发生,14例患者存在大腿外侧疼痛(11.0％),5例大腿内侧疼痛(3.9 ％),4例疼痛较重者给予对症治疗后好转. 结论 亚洲型股骨近端PFNA-Ⅱ治疗老年股骨粗隆间骨折具有手术操作简单,并发症少,临床疗效好等优点,但其长期疗效尚需大样本、多中心观察.
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