新一代髓内钉InterTAN在股骨转子间骨折治疗中的应用

目的 探讨新一代髓内钉InterTAN治疗股骨转子间骨折的适应证、手术技巧及临床疗效.方法 2008年12月到2009年12月采用新一代髓内钉InterTAN内固定治疗53例股骨转子间骨折患者,男20例,女33例;平均年龄79.3岁（60～95岁）.骨折根据改良Evan分型：均为顺转子间骨折,其中ⅠA型2例,ⅠB型7例;ⅡA型4例,ⅡB型18例;Ⅲ型22例.记录并对比患者伤前及术后6个月SF36量表评分,对患者术后3个月和6个月的X线片进行评价.结果 所有患者术后获平均8.3个月（6～15个月）随访,期间死亡3例（5.7%）.51例患者3个月内获临床愈合,平均愈合时间为（11.5±0.8）周.1例术后6周出现拉力螺钉切出股骨头,行螺钉位置调整术后12周获骨折愈合.伤前SF36量表评分平均为（106.0±16.1）分,术后6个月平均为（102.3±17.5）分,差异无统计学意义（t=0.176,P=0.247）.61.5%（32/52）的患者（获随访53例,去掉术后14 d死亡1例）SF36量表评分恢复至伤前水平.结论 新一代髓内钉InterTAN固定术可用于治疗粉碎、复杂及合并骨质疏松的股骨转子间骨折;其设计更符合股骨近端生物力学特征,能有效恢复股骨近端稳定性,减少卧床时间,提高生活质量,降低死亡率及并发症.

Clinical application of InterTAN in treatment of proximal femoral fractures

Objective To study the indications, operation skills and clinical outcome of InterTAN,a new generation of intramedullary locking nails. Methods A series of 53 cases of femoral intertrochanteric fracture were fixed by InterTAN from December 2008 to December 2009. They were 20 males and 33 females. Their average age was 79. 3 years old (ranging from 60 to 95 years) . By Evans-Jensen classification, there were 2 cases of type ⅠA, 7 type ⅠB, 4 type ⅡA, 18 type ⅡB, and 22 type Ⅲ. All cases were internally fixed with InterTAN after close reduction. Results The follow-ups averaged 8.3 months (range, 6 to 15 months). Three cases died during the follow-ups (mortality, 5.7% ). Of all the patients, 51got bone healing in 3 months, with an average healing time of (11.5 ±0. 8) weeks. One case suffered cut-out of lag screws at 6 weeks but obtained bone union 12 weeks after adjustment of screw position. Conclusion As a new generation of intramedullary nails, InterTAN is successful in treating comminuted, complex and osteoporotic proximal femoral fractures, because, designed according to the bio-mechanical characteristics of the proximal femur, it can restore the stability effectively, shorten the bed-ridden time, and reduce mortality and complications.