[1]刘中砥,徐海林,陈建海,等.解剖型股骨近端髓内钉治疗老年转子间骨折的初步疗效[J].中华老年骨科与康复电子杂志,2017,(05):265-269.[doi:10.3877/cma.j.issn.2096-0263.2017.05.003]
　Liu Zhongdi,Xu Hailin,Chen Jianhai,et al.Clinical effectiveness of Zimmer Natural Nail System (ZNN) for treatment of elderly intertrochanteric fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(05):265-269.[doi:10.3877/cma.j.issn.2096-0263.2017.05.003]
点击复制

解剖型股骨近端髓内钉治疗老年转子间骨折的初步疗效()
分享到：

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2017年05期
页码:
265-269
栏目:
髋部骨折
出版日期:
2017-09-18

文章信息/Info

Title:
Clinical effectiveness of Zimmer Natural Nail System (ZNN) for treatment of elderly intertrochanteric fractures
作者:
刘中砥; 徐海林; 陈建海; 薛峰; 党育; 张培训
100044 北京大学人民医院创伤骨科
Author(s):
Liu Zhongdi;  Xu Hailin;  Chen Jianhai;  Xue Feng;  Dang Yu;  Zhang Peixun
Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
关键词:
髋骨折;  骨折固定术; 髓内;  股骨近端髓内钉;  老年人
Keywords:
Hip fractures;  Internal fixation;  intramedullary;  Proximal femoral nail;  Aged
DOI:
10.3877/cma.j.issn.2096-0263.2017.05.003
文献标志码:
A
摘要:
目的 评价解剖型股骨近端髓内钉（ZNN）治疗老年股骨转子间骨折的初步疗效。方法 回顾性分析2016年9月至2017年1月北京大学人民医院创伤骨科收治的18例老年股骨转子间骨折患者的治疗过程，Evans-Jensen分型中，Ⅱ型8例，Ⅲ型6例，Ⅳ型骨折4例；所有入组患者均采用闭合牵引复位ZNN内固定术治疗。记录分析患者的手术时间、术中出血量及骨折愈合情况，采用Harris评分系统以及Charnley髋关节功能评分标准评估患髋功能恢复情况。结果 18例患者的平均手术时间为（67±21）min，术中出血量为（75±29）ml，住院天数为（14±6）d。末次随访时，12例患者达到骨性愈合的平均时间为（16.0±1.5）w，Harris评分优8例，良4例，优良率100%；Charnley髋关节功能评分标准优6例，良5例，可1例，优良率91.7%。结论 解剖型股骨近端髓内钉操作简单，出血少，固定牢固，可作为治疗老年股骨转子间骨折的优选方案。
Abstract:
Objective To evaluate the clinical efficacy of Zimmer Natural Nail System (ZNN) in the treatment of intertrochanteric fractures in elderly patients. Methods A retrospective study was performed in 18 cases of elderly intertrochanteric fractures in people’s Hospital, peking university from September 2016 to January 2017. According to Evans-Jensen classification, 8 cases were Ⅱ, 6 Ⅲ, 4 Ⅳ. All patients were treated with closed reduction and Zimmer Natural Nail System fixation. The operation time, blood loss, time of fracture healing was recorded, the Harris and Charnley scoring system were used to assess hip function. Results The average operation time of 18 patients was 67±21 min, the average blood loss was 75±29 ml, the average hospital stay was 14 ±6 d. 12 cases reach healing with an average time of 16.0±1.5 weeks, the Harris score was excellent in 8 cases, good in 4 cases, with the excellent rate of 100%, the Charnley score was excellent in 6 cases, good in 5 cases and common in 1 case, with the excellent rate of 91.7%. Conclusion The Zimmer Natural Nail System is a good choice for the treatment of intertrochanteric fractures in elderly patients with simple operation, less blood loss and firm fixation.

参考文献/References:

1 Banks E, Reeves GK, Beral V, et al. Hip fracture incidence in relation to age, menopausal status, and age at menopause: prospective analysis [J]. PLoS Med, 2009, 6(11): e1000181.
2 Fox GN. Preventing hip fractures in older patients with fall risk [J]. Am Fam Physician, 2003, 68(3): 420.
3 Ftouh S, Morga A, Swift C, et al. Management of hip fracture in adults: summary of NICE guidance [J]. BMJ, 2011, 342: d3304.
4 Gdalevich M, Cohen D, Yosef D, et al. Morbidity and mortality after hip fracture: the impact of operative delay [J]. Arch Orthop Trauma Surg, 2004, 124(5): 334-340.
5 Panula J, Pihlajamaki H, Mattila VM, et al. Mortality and cause of death in hip fracture patients aged 65 or older - a population-based study [J]. BMC Musculoskelet Disord, 2011, 12: 105.
6 Bateman L, Vuppala S, Porada P, et al. Medical management in the acute hip fracture patient: a comprehensive review for the internist [J]. Ochsner J, 2012, 12(2): 101-110.
7 Jones GR, Miller TA, Petrella RJ. Evaluation of rehabilitation outcomes in older patients with hip fractures [J]. Am J Phys Med Rehabil, 2002, 81(7): 489-497.
8 Marufu TC, White SM, Griffiths R, et al. Prediction of 30-day mortality after hip fracture surgery by the Nottingham Hip Fracture Score and the Surgical Outcome Risk Tool [J]. Anaesthesia, 2016, 71(5): 515-521.
9 Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium-2007 - Orthopaedic Trauma Association classification, database and outcomes committee [J]. J Orthop Trauma, 2007, 21(10, S): S1-S133.
10 Parker M, Johansen A. Hip fracture [J]. BMJ, 2006, 333(7557): 27-30.
11 Shah AA, Kumar S, Shakoor A, et al. Do delays in surgery affect outcomes in patients with inter-trochanteric fractures? [J]. J Pak Med Assoc, 2015, 65(11 Suppl 3): S21-S24.
12 Souza RC, Pinheiro RS, Coeli CM, et al. [Risk adjustment measures for mortality after hip fracture] [J]. Rev Saude Publica, 2007, 41(4): 625-631.
13 Ozturk A, Ozkan Y, Akgoz S, et al. The risk factors for mortality in elderly patients with hip fractures: postoperative one-year results [J]. Singapore Med J, 2010, 51(2): 137-143.
14 Palm H, Posner E, Ahler-Toftehoj HU, et al. High reliability of an algorithm for choice of implants in hip fracture patients [J]. Int Orthop, 2013, 37(6): 1121-1126.
15 Richmond J, Aharonoff GB, Zuckerman JD, et al. Mortality risk after hip fracture. 2003 [J]. J Orthop Trauma, 2003, 17(8 Suppl): S2-S5.
16 Kanis JA, Odén A, Mccloskey EV, et al. A systematic review of hip fracture incidence and probability of fracture worldwide [J]. Osteoporos Int, 2012, 23(9): 2239-2256.
17 Marks R. Hip fracture epidemiological trends, outcomes, and risk factors, 1970-2009 [J]. Int J Gen Med, 2010, 3: 1-17.
18 Pillai A, Eranki V, Shenoy R, et al. Age related incidence and early outcomes of hip fractures: a prospective cohort study of 1177 patients [J]. J Orthop Surg Res, 2011, 6: 5.
19 Pisani P, Renna MD, Conversano F, et al. Major osteoporotic fragility fractures:Risk factor updates and societal impact [J]. World J Orthop, 2016, 7(3): 171-181.
20 Eqol KA, Chang EY, Cvitkovic J, et al. Mismatch of current intramedullary nails with the anteriro bow of the femur [J]. J Orthop Trauma, 2004, 18(7): 410-415.
21 Maratt J, Schilling PL, Holcombe S, et al. Variation in the femoral bow – a noval high-throughput analysis of 3922 femurs on cross-sectional imaging [J]. J Orthop Trauma, 2014, 28(1): 6-9
22 Chang SM, Song DL, Ma Z, et al. Mismatch of the short straight cephalomedullary nail (PFNA-II) with the anterior bow of the femur in an Asian population [J]. J Orthop Trauma, 2014, 28(1): 17-22.

相似文献/References:

[1]吴斗,郝海虎,朱剑,等.老年髋部骨折术后谵妄的危险因素分析[J].中华老年骨科与康复电子杂志,2015,(01):34.
[2]姬晨妮,陈伟,朱燕宾,等.京津唐地区1 583例老年股骨转子间骨折流行病学特征分析[J].中华老年骨科与康复电子杂志,2015,(01):45.
[3]沈鹏程 朱立帆 蒋富贵 鞠文 徐能 李晓林.锁定钢板结合重建肱骨内侧柱治疗老年不稳定型肱骨近端骨折的疗效分析[J].中华老年骨科与康复电子杂志,2015,(02):7.[doi:10.3877/cma.j.issn.2096-0263.2015.02.002]
　Shen Pengcheng,Zhu Lifan,Jiang Fugui,et al.Clinical research of locking plate combined with medial column mechanical support for unstable fractures of the proximal humerus in elderly patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2015,(05):7.[doi:10.3877/cma.j.issn.2096-0263.2015.02.002]
[4]裴宝瑞,吴啸波,李力更,等.应用低分子肝素钙预防老年髋部骨折术前静脉血栓栓塞症的剂量研究[J].中华老年骨科与康复电子杂志,2016,(02):76.[doi:10.3877/cma.j.issn.2096-0263.2016.02.003]
　Pei Baorui,Wu Xiaobo,Li Ligeng,et al.The efficacy of low molecular weight heparin calcium of preventive versus therapeutic dose in prevention of venous thromboembolism in elderly patients before hip fracture surgery[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):76.[doi:10.3877/cma.j.issn.2096-0263.2016.02.003]
[5]李梦远,陈宏　马元琛,廖俊星,等.老年髋部骨折内固定失败后补救性髋关节置换术的临床研究[J].中华老年骨科与康复电子杂志,2016,(02):81.[doi:10.3877/cma.j.issn.2096-0263.2016.02.004]
　Li Mengyuan,Chen Hong,Ma Yuanchen,et al.Clinical research of hip arthroplasty as a salvage treatment after reduction and fixation failure in the proximal femoral fracture[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):81.[doi:10.3877/cma.j.issn.2096-0263.2016.02.004]
[6]钟俊青,王连成.快速外科通道理念对老年股骨转子间骨折围手术期康复指导的前瞻性研究[J].中华老年骨科与康复电子杂志,2016,(02):87.[doi:10.3877/cma.j.issn.2096-0263.2016.02.005]
　Zhong Junqing,Wang Liancheng..Prospective study of the effect of fast track surery on peri-operative rehabilitation of elderly intertrochanteric fracture[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):87.[doi:10.3877/cma.j.issn.2096-0263.2016.02.005]
[7]吴啸波,裴宝瑞.老年髋部骨折围手术期相关问题的研究进展[J].中华老年骨科与康复电子杂志,2016,(02):114.[doi:10.3877/cma.j.issn.2096-0263.2016.02.010]
　Wu Xiaobo,Pei Baorui..Perioperative related problems of surgery in elderly patients with hip fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):114.[doi:10.3877/cma.j.issn.2096-0263.2016.02.010]
[8]黄晓文,公茂琪,查晔军,等.早期快速闭合复位空心钉内固定治疗高龄股骨颈骨折的临床研究[J].中华老年骨科与康复电子杂志,2017,(01):4.[doi:10.3877/cma.j.issn.2096-0263.2017.01.002]
　Huang Xiaowen,Gong Maoqi,Zha Yejun,et al.Clinical results of early and rapid close reduction with internal fixation cannulated screws for femoral neck fractures in elderly patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(05):4.[doi:10.3877/cma.j.issn.2096-0263.2017.01.002]
[9]黄鑫,苏柯,王晓宁,等.围手术期内科并存病对高龄股骨转子间骨折术后疗效的影响[J].中华老年骨科与康复电子杂志,2017,(01):11.[doi:10.3877/cma.j.issn.2096-0263.2017.01.003]
　Huang xin,Su Ke,Wang Xiaoning,et al.Influence of preoperative complications on the clinical outcome of elderly intertrochanteric fractures patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(05):11.[doi:10.3877/cma.j.issn.2096-0263.2017.01.003]
[10]李坛珠,张保焜,莫小联,等.极高龄不稳定股骨粗隆间骨折的髓内和髓外固定疗效比较[J].中华老年骨科与康复电子杂志,2017,(01):17.[doi:10.3877/cma.j.issn.2096-0263.2017.01.004]
　Li Tanzhu,Zhang Baokun,Mo Xiaolian,et al.The comparative analysis of extramedullary to intramedullary fixations for unstable femur intertrochanteric fractures in elderly patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(05):17.[doi:10.3877/cma.j.issn.2096-0263.2017.01.004]
[11]张静,李志锐,唐佩福.老年粗隆间骨折的手术治疗进展[J].中华老年骨科与康复电子杂志,2016,(04):250.[doi:10.3877/cma.j.issn.2096-0263.2016.04.011]
　Li Zhirui,Zhang Jing,Tang Peifu.Progress of surgical treatment for femoral intertrochanteric fracture in the elderly patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(05):250.[doi:10.3877/cma.j.issn.2096-0263.2016.04.011]
[12]陈佳,李西成.髋部骨折：争议与挑战[J].中华老年骨科与康复电子杂志,2017,(04):193.[doi:10.3877/cma.j.issn.2096-0263.2017.04.001]
　Chen Jia,Li Xicheng.Hip fracture: Controversy and challenge[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(05):193.[doi:10.3877/cma.j.issn.2096-0263.2017.04.001]
[13]佟大可,刘培钊,丁晨,等.股骨转子间骨折髓内固定复位丢失的预防措施及疗效评价[J].中华老年骨科与康复电子杂志,2017,(04):210.[doi:10.3877/cma.j.issn.2096-0263.2017.04.004]
　Tong Dake,Liu Peizhao,Ding Chen,et al.Preventive measures and outcome evaluation of reduction loss of intramedullary fixation for femoral intertrochanteric fracture[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(05):210.[doi:10.3877/cma.j.issn.2096-0263.2017.04.004]
[14]王喆,李盛龙,汤欣,等.InterTAN与 PFNA-II髓内固定系统在老年髋部骨折中的临床疗效分析[J].中华老年骨科与康复电子杂志,2017,(04):216.[doi:10.3877/cma.j.issn.2096-0263.2017.04.005]
　Wang Zhe,Li Shenglong,Tang Xin,et al.InterTAN versus PFNA- II intramedullary nailing in the treatment of geriatric femoral intertrochanteric fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(05):216.[doi:10.3877/cma.j.issn.2096-0263.2017.04.005]
[15]宫福良,田康,李杰.髓内外内固定治疗老年人股骨粗隆间骨折的疗效比较[J].中华老年骨科与康复电子杂志,2017,(06):356.[doi:10.3877/cma.j.issn.2096-0263.2017.06.008]
　Gong Fuliang,Tian Kang,Li Jie..Comparative study of different internal fixation methods for the treatment of senile intertrochanteric fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(05):356.[doi:10.3877/cma.j.issn.2096-0263.2017.06.008]

备注/Memo

备注/Memo:
基金项目：国家重点基础研究发展计划（973计划）（2014CB542201），国家高技术研究发展计划（863计划）（SS2015AA020501），国家自然科学基金（31771322，31571235，31571236，31271284， 31171150）
更新日期/Last Update: 2017-09-15