抗旋型股骨近端髓内钉治疗股骨粗隆下骨折的临床观察

Clinical observations on proximal femoral nail anti-rotation in treatment of subtrochanteric fractures

目的讨论采用抗旋型股骨近端髓内钉((proximal femur nail A,PFNA)内固定治疗股骨粗隆下骨折的临床效果。方法收集2008年6月～2011年1月我科收治的股骨粗隆下骨折23例病例资料,Seinsheiner分型Ⅱ型9例,Ⅲ型7例,Ⅳ型5例,Ⅴ型2例。采用闭合或有限切开,复位满意后,行PFNA内固定治疗。结果 23例均获随访,随访时间9～40个月,平均20个月。全部获得骨性愈合,平均愈合时间为4.5个月。根据改良Harris髋关节评分标准进行功能评价:优17例,良6例;优良率100%。结论 PFNA治疗股骨粗隆下骨折,具有操作方便、损伤小、术中出血少、有利于骨折愈合、内固定坚强稳定、术后能辅以髋膝关节的早期功能锻炼等优点,对股骨粗隆下骨折有较好的临床治疗效果。

Objective To discuss the clinical outcome of proximal femoral nail anti-rotation（PFNA） in treatment of subtrochanteric fractures.Methods There were 23 patients with traumatic subtrochanteric fractures from Jun.2008 to Jan.2011.According to Seinsheiner classification of subtroehanteric fractures,9 patients were with type Ⅱ fractures,7 with type Ⅲ fractures,5 with type IV fractures and 2 with type V fractures.Close reduction or open reduction was performed through a mini-incision before inserting the nail.Results Totally 23 patients（100%,23/23）were followed up for 9-40 months,with a mean duration of 20 months.Bony union was observed in all patients,with a mean union period of 4.5 months.According to Modified Harris Hip Scale,the results were excellent in 17 patients,good in 6,with excellent and good rate of 100%.Conclusion PFNA in treatment of subtrochanteric fractures has advantages of easy operation,less damage and less bleeding.It’s helpful for fracture healing.Stable internal fixation could allow patients with early hip and knee joint functional exercise to reduce the complications.So PFNA is an effective device for treatment of subtrochanteric fracture.