股骨近端防旋髓内钉治疗老年股骨转子间骨折112例

目的 探讨股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)治疗老年股骨转子间骨折的手术疗效.方法 自2007年4月至2009年7月应用PFNA治疗股骨转子间骨折112例,其中男34例,女78例；平均年龄76岁.AO分型:31 -A2型80例,31 -A3型32例.Singh指数分类:Ⅰ级4例,Ⅱ级21例,Ⅲ级70例,Ⅳ级15例；骨折前2例跛行.低能量损伤97例,高能量损伤15例.采用Salvati - Wilson评分对髋关节功能进行评估.结果 112例患者中90例接受12 ～24个月随访,平均18.6个月.Salvati - Wilson评分为(29.98±5.18)分:优41例,良40例,可6例,差3例,优良率为90％.术中主要问题为插钉困难22例,其中3例患者在插钉过程中导致股骨近端外侧皮质破裂.敲击螺旋刀片过程中造成骨折断端不同程度的移位或分离34例,远端锁钉困难9例.术后并发症中局部并发症包括髋部疼痛21例,股部疼痛4例,明显髋内翻2例,延迟愈合7例.无论Singh指数为何种类型均未见螺旋刀片切出或穿透股骨头,也未见股骨干骨折发生.全身并发症包括心脑血管疾病1例,肺部感染4例,深静脉栓塞1例,会阴部淤血或肿胀17例.结论 PFNA是治疗股骨转子间骨折特别是骨质疏松性骨折的有效方法,但骨折延迟愈合以及髓内钉与股骨近端形态的不匹配还有待进一步解决.

Proximal femoral nail antirotation for treatment of intertrochanteric fractures: an analysis of 112 patients

Objective To investigate the clinical value of proximal femoral nail antirotation ( PFNA) in treatment of intertrochanteric fractures.Methods From April 2007 to July 2009,112 patients with intertrochanteric fractures were treated by using PFNA.There were 34 males and 78 females,at mean age of 76 years.Of all,80 patients were with type 31-A2 fracture and 32 with type 31-A3 fractures according to AO classification.According to Singh index classification,there were 4 patients at grade Ⅰ,21 at grade Ⅱ,70 at grade Ⅲ and 15 at grade Ⅳ.The fracture was caused by low-energy injury in 97 patients and by high-energy injury in 15.The Salvati-Wilson score was used to evaluate the hip function postoperatively.Results Ninety patients received 12-24 months follow-up (average 18.6 months).The Salvati-Wilson score was (29.98 ± 5.18 ) points.The result was excellent in 41 patients,good in 40,fair in 6 and poor in 3,with excellenct rate of 90％.The introduction of the nail in operation was difficult in 22 patients,of which 3 patients suffered femoral cortex rupture.Displacement or separation of the fracture segments occurred in 34 patients and distal locking difficulty in nine during the screw blade tapping process.Local complications included hip pain in 21 patients,thigh pain in 4,apparent coxa vara in 2 and delayed healing in 7.There were no cutting-out or femoral shaft fractures no matter what type of Singh index was.The systemic complications included cardiovascular and cerebrovascular disease in one patient,pulmonary infection in four,deep vein embolism in one and perineum congestion or swelling in seventeen.Conclusion PFNA is effective in treating intertrochanteric fractures especially osteoporotic fractures,but delayed healing of the fractures and the mismatch between the intramedullary nail and the proximal femoral morphology remain to be addressed.