骨水泥增强股骨近端抗旋钉治疗骨质疏松性股骨粗隆间骨折

Hongfeng Chen, Dongsong Yang, J. Ling, Peng-fei Chen, Zhen Li, Pengru Wang, Guangliang Wu, Guangrong Yu
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引用次数: 0

摘要

目的观察骨水泥增强股骨近端抗旋转钉(PFNA)治疗骨质疏松性股骨粗隆间骨折的疗效。方法2016年1月至2017年6月,在漯河医学院第二附属医院骨科对23例严重骨质疏松性转子间骨折患者进行骨水泥增强PFNA治疗。他们是9名男性和14名女性,平均年龄为85.3岁(从80岁到91岁不等)。根据AO/OTA-2018分类,31-A1.3型2例,31-A2.2型5例,31-A.23型13例,31-A3.3型3例。根据辛格标准分级,4例为1级,16例为2级,3例为3级。骨水泥增强了PFNA的固定。记录最后一次随访时的手术时间、术中出血量、术后并发症、骨折愈合时间和髋关节Harris评分。结果手术时间平均56.3分钟(47~91分钟),术中出血量平均197毫升(110~450毫升)。所有患者均进行了5至27个月(平均14.7个月)的随访。一名Harris髋关节评分为良好的患者在手术后5个月死于急性化脓性梗阻性胆管炎。23处骨折均骨性愈合。愈合时间平均为11.3周(范围为8-18周)。根据上次随访的Harris评分,优11例,良10例,尚可2例,优良率91.3%。关键词:髋部骨折;骨折固定,髓内;骨钉;骨质疏松症;骨水泥
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Bone cement-enhanced proximal femoral nail antirotation for treatment of severe osteoporotic intertrochanteric fracture
Objective To observe the effectiveness of bone cement-enhanced proximal femoral nail antirotation (PFNA) in the treatment of severe osteoporotic intertrochanteric fracture. Methods Between January 2016 and June 2017, 23 patients with severe osteoporotic intertrochanteric fracture were treated with bone cement-enhanced PFNA at Department of Orthopaedics, The Second Affiliated Hospital to Luohe Medical College. They were 9 men and 14 women with an average age of 85.3 years (range, from 80 to 91 years). According to AO/OTA-2018 classification, there were 2 cases of type 31-A1.3, 5 cases of type 31-A2.2, 13 cases of type 31-A2.3 and 3 cases of type 31-A3.3. According to Singh standard grading, 4 cases were rated as level 1, 16 cases as level 2 and 3 cases as level 3. The PFNA fixation was enhanced by bone cement in all. The operation time, amount of intraoperative bleeding, postoperative complications, fracture healing time and hip Harris scores at the last follow-up were recorded. Results The operation time averaged 56.3 minutes (range, from 47 to 91 minutes) and the amount of intraoperative bleeding 197 mL (range, from 110 to 450 mL). All patients were followed up for 5 to 27 months (mean, 14.7 months). One patient who had been rated as good by the Harris hip score died 5 months after surgery because of acute suppurative obstructive cholangitis. All the 23 fractures achieved bony union. The healing time averaged 11.3 weeks (range, from 8 to 18 weeks). By the Harris scores at the last follow-up, 11 cases were excellent, 10 cases good and 2 cases fair, giving an excellent and good rate of 91.3%. Conclusion Bone cement-enhanced PFNA can bring about good short-term outcomes for severe osteoporotic intertrochanteric fractures because it can improve the screw control and reduce the risk of internal fixation failure. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails; Osteoporosis; Bone cement
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