股骨近端髓内钉-螺旋刀片治疗股骨转子间骨折的疗效分析

The Curative Effect and Complications of Proximal Femoral Nail with Spiral Blade Fixation in the Treatment of Intertrochanteric and Subtrochanteric Fracture in Adults

目的:探讨股骨近端髓内钉-螺旋刀片(PFNA)治疗成人股骨转子间骨折的疗效及并发症。方法:自2006年10月～2007年5月,采用闭合复位PFNA固定治疗20例成人股骨转子间骨折患者,其中Evans-Jensen15例,Ⅲ型5例。结果:5例闭合复位失败,改用切开复位DHS固定(2例)及有限切开PFNA固定(3例)。18例PFNA固定患者均获15～21个月随访,切口均I期愈合,无主钉及锁钉松动、断裂,螺旋刀片切割、退出,股骨头缺血性坏死等并发症,但1例发生髋内翻。骨折均获骨性愈合,平均愈合时间17.1周。髋关节功能Harris评分:优13例,良4例,可1例,优良率为94.44%。结论:PFNA治疗成人股骨转子间骨折具有微创,操作简捷,固定可靠等特点,近期疗效满意,但仍有术中并发症发生。

Objective：To evaluate the effect and complications of proximal femoral nail with spiral blade fixation in the treatment of peritrochanteric fractures in adults.Methods：From October 2006 to May 2007,15 cases of intertrochanteric fractures and 5 cases of subtrochanteric fractures were treated with closed reduction and proximal femoral nail with spiral blade.Results：Closed reduction in 5 cases failed.Thus,2 of them were converted to open reduction plus DHS fixation and 3 were treated with open reduction and proximal femoral nail with spiral blade fixation.Eighteen patients were followed up for 15 to 21 months.No infection,nonunion,cut-out of helical blade,failures of nails or ischemic necrosis of femoral head were found in the 18 cases,but one case had coxa vara.All fractures obtained bone union and the average healing time was 17.1 weeks.According to Harris scoring system,there were excellent results in 13 cases,good results in 4 cases,fair in 1 case,with the excellent and good rate 94.44%.Conclusion：Proximal femoral nail with spiral blade fixation has the advantages of mini-invasion,convenient manipulation,stable fixation and results in satisfactory outcomes at a short clinical phase.But it has a certain degree of incidence of intraoperative complications which can be affected by the operator＇s performance.