加长型股骨近端髓内钉内固定治疗股骨转子间合并股骨干中段骨折

Treatment of femoral intertrochanteric fracture combined middle femoral fractures by long PFN internal fixation

目的总结加长型股骨近端髓内钉(PFN)内固定治疗股骨转子间骨折合并股骨干中段骨折的经验。方法对10例股骨转子间骨折合并股骨干中段骨折采用此种加长型PFN内固定手术治疗(股骨转子间骨折Evans分型:Ⅰ型1例,Ⅱ型3例,Ⅲ型5例,Ⅳ型1例)。结果随访3～15个月,平均9个月,髋关节Harris评分:优6例,良3例,可1例;股骨干按马元璋评分:优6例,良4例。结论术中保持下肢力线正常,尽可能恢复股骨转子后内侧皮质的完整性;正确的操作、固定钉固定于恰当位置及术后正确功能锻炼是取得良好疗效的关键。

Objective To summarize the experience on treatment of intertrochanteric combined middle femoral fractures by long PFN internal fixation. Methods 10 cases with intertrochanteric combined middle femoral fractures were treated by long PFN internal fixation. There were 1 case of Evans type Ⅰ,3 of type Ⅱ,5 of type Ⅲ, and 1 of type Ⅳ. Results All the patients were followed up for 3~15 months with average of 9 months. According to Harris hip joint score system, 6 patients had excellent results, 3 good and 1 fair in clinical evaluation; According to MA Yuan-zhang diaphyseal femoral score system, 6 patients had excellent results,4 good in clinical evaluation. Conclusions Keeping the line of weight transmission of lower extremity in normal and preservation of the integrity of posterior medial cortex of femoral trochanter, precise operation, appropriate fixation apposition of nails and correct postoperative functional exercises are keys to obtain satisfactory therapeutic effect.