股骨近端髓内钉-螺旋刀片置入治疗股骨转子间骨折32例

Proximal femoral nail antirotation for 32 patients with femoral intertrochanteric fracture

目的：观察股骨近端髓内钉-螺旋刀片金属材料置入治疗股骨转子间骨折的临床疗效。方法：收集2006-10/2007-12苏州大学附属娄葑医院骨科收治所有采用股骨近端髓内钉-螺旋刀片治疗的股骨转子间骨折患者32例,男8例,女24例;年龄35-86岁,平均65岁;骨折类型参照Evans-Jenson方法分为稳定型（Ⅰ、Ⅱ型）9例和不稳定型（Ⅲ、Ⅳ、Ⅴ型）23例。分别记录患者内固定时间,住院时间,骨折平均愈合时间,测量患肢内固定后颈干角变化,及并发症发生情况。结果：32例患者中26例获完整随访资料,随访时间12-21个月,平均14个月。32例患者内固定均顺利完成,平均54min。内固定后无切口感染等并发症出现。住院时间7-19d,平均10d。骨折平均愈合时间为3.8个月,90%患者恢复术前活动能力。患者术前患肢颈干角平均为90°,内固定后颈干角恢复良好,平均132°,无髋内翻畸形,随访至今,无髓内钉断裂或螺旋刀片切出股骨头、股骨头坏死、股骨骨折等并发症发生。结论：股骨近端髓内钉-螺旋刀片置入后允许患者早期完全负重,且有效减少了其他内固定所带来的并发症,在老年骨质疏松性不稳定转子间骨折的治疗中可为一种有效方法。

OBJECTIVE： To observe the clinical effects of proximal femoral nail antirotation （PFNA） in the treatment of femoral intertrochanteric fractures. METHODS： From October 2006 to December 2007, 32 cases of intertrochanteric fractures treated with PFNA fixation in Department of Orthopedic Surgery, Loufeng Hospital, Soochow University were selected, including 8 males and 24 females with an average age of 65 years old （range 35 to 86 years）. According to Evans-Jenson classification, 9 cases were stable type （typeⅠ, Ⅱ ） and 23 cases unstable type （type Ⅲ, Ⅳ, Ⅴ ）. The operation time, the hospitalization duration and fracture healing time were recorded. The change of collodiaphyseal angle and postoperative complications were followed up. RESULTS： Of the 32 cases, 26 had complete follow-up data with an average follow up of 14 months （range 12 to 21 months）. All 32 patients successfully completed the surgery with average operation time of 54 minutes. There were no severe postoperative complications such as infection. The average hospitalization duration was 10 days （range 7 to 19 days）. The average time of the fracture healing was 3.8 months and the function of affected limbs recovered in 90% cases. The average collodiaphyseal angle was 132°. No hip varus was found. At the final follow up, no complications were found such as collapse of the implants, cutting out of the PFNA blade, necrosis of the femur head or femoral fracture. CONCLUSION： The PFNA allows immediate postoperative full weight-bearing and reduced the complications induced by other implants. It is a good method in the treatment of intertrochanteric fractures especially unstable intertrochanteric fractures caused by osteoporosis in the elderly.