股骨近端防旋髓内钉治疗股骨转子下骨折

背景：髓内钉具有优良的力学承载性能，提高了骨与内固定的整体稳定性，减少了骨折畸形愈合和内固定失败的发生率。股骨转子下骨折的内固定治疗对内植物的要求较高，因此在内植物的选择上仍存在很多争议。 目的：评价股骨近端防旋髓内钉治疗股骨转子下骨折的临床疗效。 方法：回顾性分析苏州大学附属第一医院2006年6月至2011年11月采用股骨近端防旋髓内钉内固定治疗股骨转子下骨折患者17例的病例资料。其中股骨转子下骨折合并转子间骨折9例(Seinsheimer分型Ⅴ型)，股骨转子下骨折(Seinsheimer分型ⅡB 2例，Ⅲ B 1例，Ⅳ 4例)累及股骨干骨折7例，Seinsheimer分型Ⅴ型同时累及同侧股骨干骨折1例。受伤原因：高能量损伤16例，低能量损伤1例。记录固定时间、固定时出血量、骨折愈合时间及患肢功能恢复情况。 结果与结论：固定后随访8-24个月，平均16.2个月。固定后X射线片示骨折愈合时间平均5.4个月。固定后X射线片示所有患者骨折复位良好，转子下骨折、转子间及股骨干骨折均愈合，未出现骨折移位、内固定松动及髋内翻畸形，固定时仅有1例患者出现插钉困难。固定后患者Harris髋关节功能评分优良率为88.2%。结果证实，股骨近端防旋髓内钉本身设计合理，其防旋刀片对骨折端具有抗旋转和成角稳定性，疗效较好，安全可靠，是治疗股骨转子下骨折较理想的内固定物。

Treatment of subtrochanteric femoral fractures with proximal femoral nail antirotation

BACKGROUND:Biomechanical examinations have shown that intramedullary devices are stronger and have the advantages of fixation stability, which can reduce the risk of malunion and fixation failure. The choice of fixation implant is demanded and controversy in the fixation of subtrochanteric femoral fractures. OBJECTIVE:To evaluate the therapeutic effects of proximal femoral nail antirotation on the treatment of subtrochanteric femoral fractures. METHODS:Between June 2006 and November 2011, 17 patients with traumatic subtrochanteric fractures of the femur who received proximal femoral nail antirotation were selected from First Affiliated Hospital of Soochow University and retrospectively analyzed. There were nine cases of Seinsheimer type Ⅴ, two cases of Seinsheimer ⅡB, one case of Seinsheimer ⅢB and four cases of Seinsheimer Ⅳ, and one case of Seinsheimer type Ⅴ involving ipsilateral femoral shaft. Injury cause: high-energy injuries in16 cases, and low-energy damage in one case. Operation time, intraoperative bleeding, fracture healing time and limb functional recovery were recorded. RESULTS AND CONCLUSION:All the patients were followed for 8-24 months, 16.2 months on average. Postoperative X-ray films showed that the fracture healing time was averagely 5.4 months. All of the fractures were recovered well that subtrochanteric fractures, intertrochanteric fractures and femoral shaft fractures were all healed. There was no fracture displacement, internal fixation loosening and varus deformity. Only one case showed difficulties in nail insertion. Excellence rate of Harris hip functional scores was 88.2% postoperatively. Proximal femoral nail antirotation is a reasonable design, and the helical blade can resist the rotation and stabilize the angle. The proximal femoral nail antirotation has better effects, which is an ideal internal fixation for subtrochanteric femoral fractures.