PFNA治疗股骨近段合并股骨干骨折

目的 探讨治疗同侧股骨近段合并股骨干骨折合理的治疗方法.方法 1999年至2009年我院52例手术病人,分别经由延长型PFNA及其他手术方式（股骨重建髓内钉、长DHS或者分别内固定处理）.结果 随访4～25个月,平均9.3月.骨折均愈合,分别固定手术复位较好但是功能差愈合时间长,用一套内固定物整体固定复位效果理想并且功能良好,其中应用延长型PFNA统计结果最好.结论 在同侧股骨近段合并股骨干骨折,整体固定优于分别固定,髓内固定优于髓外固定.同时长PFNA因为力学设计和手术步骤设计方面的优势使得在处理相关骨折时较有优势.以及长PFNA手术时应注意的一些问题.

Study on proximal femoral nail antirotation in surgical treatment of femoral proximal with shaft fracture

Objective To find an appropriate way in surgery treatment of ipsilateral femoral proximal fracture combine with shaft fracture.Methods We retrospectively analyzed 52 cases which came across holistic fixation [Long proximal femoral nail anti-rotation （PFNA）／Long dynamic hip screw （DHS）] or separate fixation surgery in our department from 1999 to 2009.Results All cases were followed-up for 4 to 25 months,average of 9.3 months.All of them got heal.Separate fixation group was good in reduction but worse in function and a longer healing time.Holistic fixation group was reliable in reduction and best in function.Conclusion In this circumstance holistic fixation is better than separate fixation.Intramedullary nail is better than plate.Long PFNA showed a better result in this study than any other methods,probably because of its unique structure and operation procedure.And some critical points should be focused during Long PFNA and reconstruction nail.