股骨近端防旋髓内钉治疗股骨转子间骨折

目的探讨股骨近端防旋髓内钉（PFNA）治疗股骨转子间骨折的临床疗效。2009年3月一2011年3月，采用股骨近端防旋髓内钉治疗股骨转子间骨折患者22例。骨折采用闭合复位，股骨近端防旋髓内钉固定术。结果平均手术时间65min（50～90min）。术中平均失血量270ml（150—500m1）。6例患者术中须扩髓即可放入主钉，16例患者术中无须扩髓即可放入主钉，18例患者静力交锁远端螺钉，4例患者未交锁远端螺钉。患者平均部分负重时间9d（6—24d）。平均随访时间9．5个月（6。13个月）。22例患者伤口均一期愈合，骨折愈合时间4—8个月，平均5．2个月。所有患者的术后功能均恢复到伤前水平。l例术后出现拉力螺钉切出移位，1例主钉入点偏外导致13。内翻畸形。结论股骨近端防旋髓内针可以安全地固定股骨转子间骨折。具有微创，手术时间短，出血少，抗旋转能力强，可早期功能锻炼，并发症少，是治疗股骨转予间不稳定性骨折的良好方法。

Treatment of intertrochanteric fractures fractures with the proximal femoral nail antirotation

Objective To explore the clinical outcome of intertrochanteric fractures with the proximal femoral nail anti-rotation （PFNA）. Methods Twenty-two patients for intertochanteric fractures of the femur were treated with the proximal femoral nail anti-rotation from March 2009 to March 2011. The fractures were reducted with closed reduction technique and fixed with the proximal femoral nail anti-rotation . Results The mean operative time was 65 rain （50 - 90min）. The mean operative blood loss was 270ml （150 ~ 500ml）. Reaming in 6 cases andunreaming in 16 cases daring operative procedure . With static distal loc- king nail in 18 cases and without distal locking nail in 4 cases . The median time to partical weight-bearing was 9d（ 6 - 24d）. The mean duration of follow up was 9. 5 months （6 - 13months）. The wound healing was smoothly in 22 patients. The average time of fracture heaking was5. 2 months （4 - 8months）. The postoperative fimction was recovered to premorbid status in all patients. One patient occurred the migration of cut-out of lag screw postoperatively. One patient suffered varus deformity in 13° due to the lateral entry, lag pointof the main nail . Conclusion The proximal femoral nail anti-rotation can fixed intertrochanteric fractures safely . wit1 a mina-mally invasive, shorter operative time ,less bleeding, anti-rotation capability, can be an early postoperative functional exercise,less complications,is the treatment of intertrochanteric fractures as a good way.