螺旋刀片型股骨近端髓内钉治疗股骨转子间骨折

目的 探讨螺旋刀片型股骨近端髓内钉(proximal femoral nail antirotation,PFNA)治疗股骨转子间骨折的特点、适应证、手术技巧及初期疗效. 方法 2006年3月-2007年6月,采用PFNA治疗38例股骨转子间骨折患者,男17例,女21例;年龄35-93岁,平均65.4岁.按AO分类标准:31-A1型10例,31-A2型21例,31-A3型7例.所有患者均经骨科下肢牵引床牵引闭合复位,小切口置入PFNA. 结果 本组38例患者平均手术时间50 min(35～105 min),平均出血量100 ml(30～300 ml),1例术中发生主钉远端股骨干外侧皮质劈裂.随访4～19个月,平均13个月,1例因并发症长时间卧床,32例息肢基本恢复到伤前功能,5例患肢功能较伤前减退.1例术后6个月发生脑梗死,经治疗后搀扶下可以在室内活动.所有患者均获得1期愈合,平均愈合时间9.5周.2例术后围术期发生呼吸系统疾病等并发症,其余患者均无切口感染、肺部感染、深静脉血栓、螺旋刀片切出股骨头、髋内翻等并发症.根据Harris髋关节功能评分:优20例,良13例,一般4例,差1例,优良率87%. 结论 PFNA治疗股骨转子间骨折具有创伤小、下床早、并发症少、内固定可靠、骨折愈合率高等优点,适用于各种类型转子间骨折,尤其适合老年骨质疏松患者,值得临床推广.

Intertrochanteric fractures treated with proximal femoral nail antirotation

Objective To investigate the advantages, indications, operative techniques and pre-liminary curative effect of proximal femoral nail antirotation(PFNA) in surgical treatment of intertrochan-teric fractures. Methods From March 2006 to June 2007, PFNA fixation was done on 38 patients with intertrochanteric fractures including 17 males and 21 females, at an average age of 65. 4 years(35-93 years). According to AO/ASIF classification, there were 10 patients with type 31-A1 fractures, 21 with type 31-A2 and 7 with type 31-A3. All patients were reduced through longitudinal traction on the traction table, with implantation of PFNA via a mini-incision. Results The mean operation duration was 50 minutes(35-105 minutes)and mean blood loss 100 ml(50-300 ml). All patients were successful except for 1 patient with split lateral cortical bone of distal shaft of the femur during operation. All pa-fients were followed up for average 13 months(4-19 months), which showed long-team bed stay due to severe complieations in 1 patient. Function recovery in 32 and deterioration of the injured limbs in 5. Cer-ebral infarction was found 6 months after operation in 1 patient, who was able to walk under support. Pri-mary bone union was achieved in all patients, with average healing time of 9. 5 weeks. There were no complications such as infection of incisional wound, pulmonary infection, phlebothrombosis, over incision or coxa adducta, except that 2 patients had perioperative respiratory system disease. According to Harris hip rating scale system. The result was excellent in 20 patients, good in 13, common in 4 and poor in 1, with total excellence rate of 89%. Conclusions As a new technique, PFNA has advantages of litth trauma. Early get-out-of-bed exercise, few complications, rigid fixation and high bone union rate and is suitable for all kinds of intertrochanteric fractures especially for old patients with osteoporosis.