摘要
目的分析股骨近端抗旋髓内钉(PFNA)治疗高龄不稳定性股骨转子间骨折的手术效果,评价其临床疗效,探讨围手术期失血、手术技巧等相关问题。方法 2008年7月～2010年12月对18例高龄股骨转子间骨折患者行PFNA内固定术。骨折按AO分型;骨质疏松评估按Singh指数法分度标准;术后髋关节功能行Harris评分。根据身高、体重和手术前后血细胞比容(HCT)变化,通过Gross方程计算围手术期失血量。结果此类术式围手术期存在较大的隐性失血。1例术后第1天出现谵妄,经治疗后恢复。全组术后无感染、骨折不愈合、脂肪栓塞、深静脉血栓形成、髋内翻及旋转畸形、头颈钉穿出股骨头等并发症。骨折全部愈合,髋关节功能良好,患者满意度良好。结论 PFNA具有操作简单、骨折固定稳定、符合生物力学固定原则等优点,对高龄不稳定的股骨转子间骨折是一种良好的内固定方法,同时PFNA手术围手术期隐性失血量较大,可能会导致术后贫血。
Objective To analyze the clinical effect of proximal femoral nail anti-rotation（PFNA） on intertrochanteric fracture（IF） in elderly patients and to investigate the related issues such as the perioperative blood loss and surgical technique.Methods Eighteen IF patients who received PFNA internal fixation from Jul.2008 to Dec.2010 were included in this study.Fracture classification was performed based on AO type.Evaluation of osteoporosis was based on Singh index and hip joint on postoperative Harris score.The blood volume and its estimated loss were calculated by Gross equation according to the changes of pre-and post-operative haemocrit（Hct）.Results Occult bleeding was observed in the perioperative period.In one case,patient showed delirium on day 1,and recovered after treatment.Complications such as infection,fracture nonunion,fat embolism,deep venous thrombosis,coxa vara,rotational deformity and nail piercing the femoral head were not detected.Fracture union was detected in all patients,and the hip joint function was in a good state.Conclusion PFNA fixation has advantages of simple manipulation,good function in fracture fixation,and being consistent with the biomechanics principle.Thus,it should be the preferred treatment method for intertrochanteric fracture（IF） in elderly patients.Meanwhile,PFNA fixation can cause considerable hidden blood loss,which may lead to severe postoperative anemia.
出处
《创伤外科杂志》
2012年第2期144-146,共3页
Journal of Traumatic Surgery
关键词
股骨骨折
髓内钉
内固定
老年
femur fracture
intramedullary nail
internal fixation
elderly
