PF膨胀式髓内钉治疗股骨转子间骨折

Clinical application of PF expandable intramedullary nail for the treatment of intertrochanteric hip fracture

目的探讨PF膨胀式髓内钉治疗股骨转子间骨折的疗效及注意事项。方法2004年3月至2006年1月，收治95例新鲜股骨转子间骨折患者，其中采用PF膨胀式（自锁式）髓内钉治疗并有完整随访资料的患者29例，男12例，女17例；年龄65-97岁，平均71．8岁；均为闭合性骨折；右侧11例，左侧18例。按Jensen和Michaelsen分型：ⅠA型2例，ⅠB型5例，ⅡA型2例，ⅡB型12例，Ⅲ型8例。结果随访时间6-19个月，平均10．5个月。所有病例均骨性愈合，骨折愈合时间8-12周，平均10．1周。术中出血量40-80ml，平均50ml；手术时间30-55min，平均37．1min；切口3-4cm，平均3．5cm；术后引流量10-150ml，平均50ml。2例患者术后出现轻度髋内翻，1例大腿中上部疼痛。无一例发生感染。结论PF膨胀式髓内钉应力分布均匀，骨折固定牢固。术前应仔细阅读X线片，了解髓腔大小，避免反复过度扩髓。注水加压过程中须多次缓慢加压，避免一次加压过大、过猛或过早拔去压力泵而影响固定的效果。

Objective To disscuss the effect and caution of PF expendable intramedullary nail based upon its clinical application for the treatment of intertrochanteric fracture. Methods Ninety-five patients of fresh intertrochanteric hip fracture admitted from March 2004 to January 2006 were reviewed retrospectively. 29 patients （all were closed-fracture） of them used PF expendable intramedullary nail, and were well followed up. There were 12 males, 17 females, with the mean age of 71.8 yeras （ranged from 65 to 97 years）. According to Jensens and Michaelsen classification, 2 cases were type ⅠA, 5 were type ⅠB, 2 were type ⅡA, 12 were type ⅡB, 8 were type Ⅲ; 11 cases of them were right and 18 cases were left. Results These patients were followed up for 10.5 months in average （ranged from 6 to 19 months）. All of the cases have healed well, and the mean time of bone union was about 10.1 weeks （from 8 to 12 weeks）. The mean blood loss during operation was 50 ml （ranged from 40 to 80 ml）; the mean time for surgery was 37.1 minutes （ranged from 30 to 55 minutes）; the mean length of the operative wound was 3.5 cm （ranged from 3 to 4 cm）, and the mean drainage after operation was 50 ml （ranged from 10 to 150 ml）. One case had pain in root of thigh, and two cases had a little coxa vara after operation. No infection was found in all cases. Conclusion Firstly, PF expendable intramedullary nail has superior in terms of highly resistant to the rotational strength and controlling operative trauma. Secondly, despite its relatively safe than intramedullary nail system, careful inspection of radiograph preoperatively is absolutely necessary, for the purpose of knowing the medullary dimension and avoiding excessive medullary expansion. Thirdly, it is imperative for compression in a repeated, gradual and slow manner during the process of allusion. Excessive compression, violent compression and premature remove of pressure pump, which may undermine the effect of fracture fixation, are all contradicted.