辅助复位下PFNA治疗高龄患者股骨粗隆间骨折32例

摘要

目的 探讨辅助复位下股骨近端防旋髓内钉(PFNA)内固定治疗高龄患者股骨粗隆间骨折的临床疗效.方法 回顾性分析2010年1月至2016年1月南华大学附属第一医院骨科一病区收治的32例股骨粗隆间骨折高龄患者的临床资料,所有患者术中牵引床下牵引均无法直接复位,分别采用撬拨复位法、Homann拉钩辅助复位法、钳夹及环抱复位法、骨折远近端互动复位法、克氏针临时固定法进行辅助复位,复位后使用PFNA进行内固定.术后进行Harris髋关节评分及VAS疼痛评分.结果 本组32例患者术后手术切口均一期愈合,无伤口感染、血管及神经损伤等并发症.32例均获随访,随访时间16~36个月,平均25个月.末次随访时骨折均一期愈合、患侧髋关节Harris功能评分为77~89分,平均(83±6.3)分,其中优18例,良12例,可2例,优良率达94%;VAS疼痛评分由术前的(6.28±1.63)分降至术后6个月的(2.17±1.06)分,差异均具有统计学意义(P<0.05);末次随访患侧髋关节无疼痛症状.结论 对于牵引床下牵引无法直接复位的股骨粗隆间骨折高龄患者,辅助复位下PFNA能取得良好的临床疗效.%Objective To investigate the clinical efficacy of proximal femoral nail antirotaion (PFNA) after auxiliary reduction in the treatment of elderly patients with intertrochanteric fractures. Methods The clinical data of 32 cases of elderly patients with intertrochanteric fracture treated in First Ward, Department of Orthopedic Surgery, the First Affiliated Hospital of South China University from January 2010 to January 2016 were analyzed retrospectively. All patients could not be directly reduced by traction under the traction bed during operation. Auxiliary reduction was performed druing the surgery by the technique of percutaneous reduction by leverage, Homann retractor assisted reduction, clamp reduction and encircling reduction, distal end of fracture interaction reduction, temporary Kirschner wire fixation. All the patients were treated with internal fixation with PFNA after reduction. Harris hip score and VAS pain score were evaluated after operation. Results In all the 32 cases, postoperative incision healed withⅠintention, without complications such as wound infection, blood vessel and nerve injury. The 32 patients were followed up for 16 to 36 months, 25 months in average . The fracture healed withⅠintention at the last follow-up, and the Harris hip score was 77 to 89, with the average of (83±6.3), among which 18 cases were classified of excellent, 12 cases of good, and 2 cases of general. The overall rate of excellent or good result was 94%. The VAS pain score decreased from (6.28±1.63) before operation to (2.17 ± 1.06) at 6 months after operation, with statistically significant difference (P<0.05). The last follow-up showed no pain in the hip of the affected side. Conclusion PFNA after auxiliary reduction can obtain good clinical effect for elderly patients with femoral intertrochanteric fracture that can not be directly reduced under traction bed.