PFN治疗不稳定股骨粗隆间骨折的手术体会

目的探讨PFN治疗不稳定股骨粗隆间骨折的疗效及术中克氏针撬拨、临时固定的应用。方法 2004年6月-2011年10月,治疗34例股骨粗隆间骨折患者,男19例,女15例,年龄69-88岁,平均75岁,85%合并内科疾病。所有患者均为股骨单侧闭合性骨折,受伤至手术间隔为1-7d,平均4.5d,均行PFN治疗,且不同程度行采取克氏针临时固定技术,术后3d,第1、2、6、9个月随访,随访时所有患者均拍摄髋关节正侧位,临床疗效评价采用Harris髋关节功能评分标准。结果 34例患者手术时间40-90min,平均50min,术中出血量100ml-200ml,平均150ml,所有患者均获得满意随访,术后未出现感染,下肢静脉血栓及断钉等并发症,2例发现防旋螺钉穿出股骨头进入髋关节,1例加压螺钉滑出。按Harris评分标准,优良率为89%。结论 PFN治疗复杂的股骨粗隆间骨折优点多,并发症少,手术过程中克氏针撬拨、临时固定技术对复杂股骨粗隆间骨折,具有良好的辅助手术效果,提高手术速度,节约手术时间,减少手术出血量。

Surgical experience In intertrochanter Fracture Treated with PFN

Objective To investigate the Taked Kirschner temporary fixed ive method and evaluate the clinical out comes of PFN in treating intertrochanter of femoral bone.Methods From June 2004 to November 2011.34 cases of intertrochanter of femoral were treated by closed reduction or limited open reduction and fixation with PFN and Taked Kirschner temporary fixed,including19 males and 15 females with an average age of 75 years(range,69-88).All patients had closed fractures in shaft of femar.The average time from iniury to operation was 4.5 days(range,1-12 days).All fractures were fixed with the PFN.The patients were followed at 3d,1,2,6,9,month after surgery.The clinical outcomes were evaluated acocording to Harris criteria and radiological examinations.Results The mean operating time of all cases was 50 minutes(range,40-90),and the mean blood loss during surgery was 150ml(ranged,150-200ml).No complications such as infeetion,lower limb vein infarction.And breakage of the implants occurred.But 2 cases had cut-out and nail cinched and the excellent and good rate was 89%(31/34).Conclusion PFN has more good points in treating complex intertrochanter fracture and few complications.Take Kirschner temporary fixed in operting can Improve the speed of surgery,save the time of surgery to reduce surgical bleeding have a good secondary effect of surgery.