融合式股骨近端交锁髓内钉治疗老年股骨近端骨折的临床研究

Clinical Study of Proximal Femoral Interlocking Intramedullary Nail in the Treatment of Proximal Femoral Fractures in the Elderly

摘要: 目的：评价采用融合式股骨近端交锁髓内钉治疗股骨近端骨折的临床疗效。方法：2013年6月至2017年6月，我院采用融合式股骨近端交锁髓内钉治疗股骨近端骨折23例，男10例，女13例；年龄65~86岁，平均71.8岁。所有患者均为股骨单侧闭合性骨折，受伤至手术时间间隔为18 h~16 d，平均5.1 d。术后第1、3、6、12个月门诊随访，以后每年至少门诊复查1次。随访时所有患者均拍摄股骨中上段正、侧位X线片。临床疗效评价采用Harris髋关节功能评分标准。结果：23例患者手术时间45~120 min，平均65 min；术中出血量50~650 ml，平均158 ml，所有患者均为术后4~14 d下地扶拐行走。23例患者均获得完整随访，随访期间所有患者均未出现感染、下肢静脉血栓、螺旋刀片切割股骨头及断钉现象，3例出现髋内翻短缩畸形，无骨折不愈合患者。骨折愈合时间为4.5~8.7个月，平均5.6个月。按Harris髋关节功能评分标准：优12例，良7例，中4例，优良率82.17% (23/19)。结论：融合式股骨近端交锁髓内钉治疗方法具有微创、固定强度高、生物力学特性好等优点，在治疗老年股骨近端骨折时骨愈合率较高、功能恢复较快、并发症较少。

Abstract: Objective: To evaluate the clinical efficacy of proximal femoral interlocking intramedullary nail in the treatment of proximal femoral fractures. Methods: From June 2013 to June 2017, 23 cases of proximal femoral fractures were treated with interlocking intramedullary nail, 10 males and 13 females, with an average age of 65 - 86 years, with an average of 71.8 years. All patients were uni-lateral closed fractures of femur. The interval between injury and operation was 18 h to 16 d, with an average of 5.1 d. The patients were followed up at 1, 3, 6 and 12 months after operation, and at least 1 times per year. All the patients were photographed with anteroposterior and lateral X-ray films of the upper and middle femur. The Harris hip function score was used to evaluate the clinical efficacy. Results: The operation time of 23 patients was 45 - 120 min, an average of 65 min; the amount of bleeding in the operation was 50 - 650 ml, with an average of 158 ml. All the patients were walking around 4 - 14 d after the operation. All the 23 patients were followed up. All the patients had no infection; venous thrombosis of the lower extremities, spiral blade cutting femoral head and nail breaking, 3 cases had coxa varus shortening deformity and no fracture nonunion. The healing time of fracture ranged from 4.5 to 8.7 months, with an average of 5.6 months. According to Harris hip joint function score, 12 cases were excellent, 7 good, 4 fair, and the excellent and good rate was 82.17% (23/19). Conclusion: The fusion method of interlocking intramedullary interlocking intramedullary nail has the advantages of minimally invasive, high fixation strength and good biomechanical properties. It has a higher bone healing rate, faster recovery of function and less complication in the treatment of proximal femoral fractures in the elderly.