股骨近端髓内钉治疗股骨粗隆间骨折体会

Experience of proximal femoral nail in treating intertrochanteric femoral fractures

目的探讨股骨近端髓内钉（proximal femoral nail,PFN）治疗股骨粗隆间骨折中的应用及效果。方法采用经髓内固定的PFN钉治疗股骨粗隆间骨折。本组病例54例,男性26例,女性28例;平均年龄60.5岁（51~78岁）。骨折分型参照Evans-Jenson分型,Ⅰ、Ⅱ型14例,Ⅲ型15例,Ⅳ型17例,Ⅴ型8例。结果平均随访14个月（6~22个月）,骨折愈合率100%。无术后感染和术后近期死亡,功能优良率为86.7%,9例输血200~400m l。结论 PFN内固定治疗粗隆间骨折操作简单、固定牢固、疗效可靠,手术并发症发生率低,可早期活动、损伤小、出血少、不输血等优点,对Evans-Jenson分型不稳定型Ⅲ、Ⅳ、Ⅴ型骨折较为适宜,是一种理想的内固定方法。

Objective To investigate the application and effect of proximal femoral nail（PFN）for the treatment of intertrochanteric fractures.Methods Intertrochanteric femoral fracture was treated by intramedullary fixation of PFN.There were 54 cases,including 26 males and 28 females,with average age of 60.5 years（ranging from 51 to 78 years）.According to the Evans-Jenson classification,there were 14 cases of typeⅠ and Ⅱ,15 cases of type Ⅲ,17 cases of type Ⅳ,8 cases of type Ⅴ.Results The average follow-up time was 14 months（ranging from 6 to 22 months）,and the fracture healing was 100%.There was no postoperative infection and postoperative death.The excellent and good rate was 86.7%.Nine cases transfused blood（200-400ml）.Conclusion PFN in treating intertrochanteric femoral fractures has advantages of simple operation,reliable fixation,low incidence of complications,early mobilization,less damage,less bleeding and no blood transfusion.The internal fixation can be more appropriate for the unstable type Ⅲ,Ⅳ,Ⅴ fracture described by Evans-Jenson classification.