髓内钉INTERTAN治疗股骨近端骨折的回顾性分析

目的探讨新一代股骨近端髓内钉INTERTAN治疗股骨近端骨折的适应证及近期临床疗效。方法回顾性分析2009年1月至8月我科使用INTERTAN治疗股骨近端骨折的患者48例,男26例,女22例,其中右侧19例,左侧29例,年龄23～89岁,平均（68.5±3.2）岁。28例为摔伤,20例为车祸伤。其中粗隆间骨折共32例,根据E-vans-Jensen分型,型4例,型7例,型11例,型7例,型3例;粗隆下骨折共16例,根据Russell-Taylor分型,A型5例,B型7例,B型4例。全部48例患者中骨质疏松Singh分级3级或3级以下者共26例（定义为明显骨质疏松）。全部患者均使用INTERTAN进行手术内固定。结果 48例患者均获得随访,随访时间5～12个月,平均（9.2±0.8）个月。手术时间40～102 min,平均（53±6.5）min。术后住院时间为5～10 d,平均（7.3±1.2）d。34例患者术后逐渐恢复到术前的行走水平。全部48例患者末次随访时的Harris评分为62～96分,平均（89.6±2.4）分,其中优19例,良21例,中6例,差2例,优良率83.33%。91.67%的患者在术后短期内疼痛缓解。骨折愈合时间8～15周,平均（10±1.8）周。2例患者末次随访时出现头颈部短缩,无畸形愈合,无骨折再移位,无内固定失效、内置物松动,无髋内翻,无股骨头缺血性坏死,无感染发生。结论新一代股骨近端髓内钉INTERTAN治疗各类型的股骨近端骨折取得良好临床效果,骨愈合率高,并发症少,尤其适用于老年人有明显骨质疏松的股骨近端骨折。

Intramedullary Nail INTERTAN for Proximal Femoral Fractures:A Retrospective Analysis Study

Objective To discuss the indications and the clinical effects of intramedullary nail INTERTAN for proximal femoral fractures.Methods We did a retrospective analysis about the intramedullary nail INTERTAN which we used for all 48 patients who were admitted to our Department of Orthopaedic Surgery during January 2009 to August 2009.These 48 patients included 26 males and 22 females,aged 68.5±3.2 years（ranging 23～89 years）,19 with right and 29 with left.The cause of 28 patients′ injuries was fall,20 was traffic accident.According to Evans-Jensen classification of 32 intertrochantericfracture patients,there were 4 cases of typeⅠ,7 of type Ⅱ,11 of type Ⅲ,7 of type Ⅳ,and 3 of type Ⅴ.According to Russell-Taylor classification of 16 subtrochanteric fracture patients,there were 5 cases of typeⅠA,7 of typeⅠB,4 of type ⅡB.26 patients were of grade 3 or below according to Singh grading （obvious osteoporosis）.All patients were treated with INTERTAN.Results All the patients were followed up by 9.2±0.8（ranging 5～12） months averagely.The average operation time was 53±6.5（ranging 40～102） min,and the post-operative hospitalization was 7.3±1.2（ranging 5～10） days.34 patients nearly restored the normal gait at the last followup.The Harris score at the final follow-up was 89.6±2.4 scores（ranging 62～96）,including 19（39.6%） cases of excellent,21（43.8%） of good,6（12.5%） of fair,2（4.2%） of poor with the good and excellent rate of 83.33%.The pain in 91.67% of the patients was relieved over a short period of time after operation.All fractures healed on the radiographs within the average of 10±1.8 weeks （ranging 8～15 weeks）.There was two collapses of the femoral neck,and there was no malunion,no re-displacement,no implants loose and internal fixation failure,no coxa vara and avascular necrosis of femoral head,and no infection.Conclusion The new intertrochanteric antegrade nail of INTERTAN can be used to treat various proximal femoral fractures with good clinical outcomes,high union rate,and rare complications,especially for the osteoporotic proximal femoral fracture in elder patients.