防旋型股骨近端髓内钉治疗股骨转子间骨折的临床研究

目的]探讨防旋型股骨近端髓内钉(proximal femoral nail antirotation,PFNA)治疗股骨转子间骨折的手术方式及临床疗效。方法]统计2007～2009年,采用PFNA治疗42例股骨转子间骨折患者。按Evans-Jensen标准分型,准确记录每例患者的手术时间、股骨近端切口长度、术中失血量、术后并发症情况、术后下床部分负重时间及术后半年髋关节Harris功能评分后进行统计学分析。结果]42例患者中的39例获得6～25个月的随访。4种骨折类型在手术时间、术中失血量、术后下床部分负重时间上相比差异具有统计学意义(P<0.05),表现为随骨折复杂程度的增加,手术难度亦逐渐加大,并且术后负重时间均相应延长。但在手术切口长度、术后并发症情况及术后Harris功能评分相比较差异无统计学意义(P>0.05)。术后半年按髋关节Harris功能评分:优13例,良18例,中6例,差2例,优良率为79.4%。结论]PFNA治疗股骨转子间骨折固定可靠,初期临床疗效满意,但对于骨折类型复杂的转子间骨折,其操作具有一定难度,医源性创伤亦较大,行有限切开复位骨折并加以辅助性固定有利于预防术后髋内翻并发症的发生。

Treatment of intertrochanteric femoral fracture with proximal femoral nail antirotation

Objective]To evaluate the clinical outcome and to inverstigate the operative method of proximal femoral nail antirotation(PFNA) in treatment of intertrochanteric femoral fracture.Method]From 2007 to 2009,42 cases of intertrochanteric femoral fracture were treated with PFNA fixation.According to Evans-Jensen classification,the data of operation time,incision length,operative blood loss,complications,partial weight bearing time and Harris hip function scores were recorded for statistics analysis.Result] Thirty-nine cases were followed up for 14.2(6-25)months averagely.There were significant differences in operation time,operative blood loss,partial weight bearing time in 4 classification groups(P<0.05),which demonstrated that,with more complicated fracture,the operation was more difficult,resulting in more bone healing time and more partial weight bearing time.However,there were no significant difference in incision length,complications and Harris hip function scores(P>0.05).Harris hip score was evaluated 6 months postoperatively,the results was excellent in 13 cases,good in 18,common in 6 and poor in 2,with total excellence and good result of 79.4%.Conclusion]Intertrochanteric femoral fractures could be treated successfully with the PFNA.However,the operation on complicated types has certainly some difficulty and leads to greater iatrogenic injury.Open reduction combined with assistant fixation is beneficial to prevent the hip varus deformation.