加长型股骨近端螺旋刀片抗旋髓内钉治疗股骨中上段长节段骨折的临床研究

目的 评价采用国际内固定研究学会(association for the study of internal fixation,AO/ASIF)加长型股骨近端螺旋刀片抗旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗股骨中上段长节段骨折的临床疗效.方法 2006年6月至2009年12月,我院采用AO/ASIF加长型PFNA治疗股骨中上段长节段骨折32例,男30例,女2例;年龄20～69岁,平均38.8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3 h～12 d,平均4.2 d.术后第1、2、3、6、9、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 32例患者手术时间35～90 min,平均55 min;术中出血量30～150 ml,平均75.6 ml,所有患者均为术后4～7 d下地扶拐行走.32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,2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3.1～5.4个月,平均3.7个月.按Harris髋关节功能评分标准:优23例,良7例,中2例,优良率93.75%(30/32).结论 AO/ASIF加长型PFNA治疗方法具有微创、固定强度高、生物力学特性好等优点,在治疗股骨中上段长节段骨折时骨愈合率高、功能恢复快、并发症少.

Treatment of long-segment fracture in middle-up part of femoral shaft with long proximal femoral nail antirotation of AO/ASIF

Objective To investigate the operative method and evaluate the clinical outcomes of long proximal femoral nail ant-rotation(PFNA-long)in treating long-segment fracture in middle-up part of femoral bone.Methods From June 2006 to December 2009,32 cases of long-segment fracture in middleup part of femoral shaft were treated by closed reduction or limited open reduction and fixation with PFNA-long,including 30 males and 2 females with an average age of 3.8.8 years(range,20-69).All patients had closed fractures in shaft of femur.The average time from injury to operation was 4.2 days(range,3 hours to 12 days).All fractures were fixed with the PFNA-long.The patients were followed at 1,2,3,6,9,12 month after surgery,respectively,and next time at least once per year.The clinical outcomes were evaluated according to Harris criteria and radiological examinations.Results The mean operating time of all cases was 55 minutes(range,35-90),and the mean blood loss during surgery was 75.6 ml(ranged,30-150 ml).All patients walked with walking aid 4-7 days after surgery.They were followed up for 9-37 months.All fractures healed after 3.1-5.4 months(mean 3.7 months).No complications such as infection,lower limb vein infarction,cut-out or breakage of the implants occurred.But 2 cases had hip internal reverse-lamb shortening malformation,According to Harris criteria,the clinical results were excellent in 23 cases,good in 7,and moderate in 2,and the excellent and good rate was 93.75%(30/32).Conclusion PFNA-long is an effective and minimally invasive method for long-segment fracture in middle-up part of femoral shaft,with minimally invasive,high fixation-strength and accord with biomechanics characteristics;and with a high rate of bone union,early functional recovery and less complications.