髓内钉InterTan治疗股骨近端骨折的早期疗效分析

Treatment of Proximal Femoral Fractures with Intramedullary Nail InterTan-Report of early Results

目的:分析应用新一代股骨近端髓内钉(InterTan)治疗股骨近端骨折的早期临床疗效。方法:回顾性分析2009年9月至2011年8月我科共收治股骨近端骨折患者共107例,均采用InterTan髓内钉系统进行治疗,其中男45例,女62例;年龄34-93岁,平均73.05岁。受伤肢体左侧63例,右侧44例。按AO分型,31-A1型32例,31-A2型59例,31-A3型16例。记录患者手术持续时间、并发症、死亡率、骨折愈合时间、末次复查Harris评分,并对比患者健侧及患侧术前、术中及术后1周的颈干角变化。所有数据采用SPSS 13.0进行统计分析。结果:平均手术持续时间为66.69分钟。颈干角:术前健侧:140.66±9.08度,术前患侧:118.00±15.49度,术中患侧:135.16±7.08度,术后1周患侧:137.51±15.21度。术前患侧颈干角与其他三组相比均有显著性差异(P<0.05),术前健侧、术中复位后患侧、术后1周患侧颈干角之间相比均无显著性差异。3例患者于随访过程中死亡,6例患者失访。98例患者获得随访,随访时间3-22个月,平均8.6个月。2例患者发生头钉切出,3例患者术后练习后出现股骨疼痛症状,未发生股骨干骨折。96例患者均获得骨性愈合,骨折愈合时间12～18周。临床疗效按Harris评分标准:41-92分,平均78.5分,优良率80.6%。结论:髓内钉InterTan是治疗股骨近端骨折的良好选择。

Objective： To analyze the indications and the clinical effects of intramedullary nail InterTan for proximal femoral frac- tures. Methods： We did a retrospective analysis about the clinical effects of treatment in proximal femoral fractures with intramedullary nail InterTan. 107 patients wo were admitted to our Department of Orthopaedic Surgery during September 2009 to August 2011. These 107 patients included 45 males and 62 females,mean aged 73.05 years（ranging 34-93 years）,44 with right and 63 with left. AO classifica- tion 32 cases of type 31-A1 ,59 cases of type 31-A2, 16 cases of type 31-A3. To record operation time; complication; mortality; healing time; Harris score; compare collodiaphyseal angle of uninjured side andpreoperative;peroperative; postoperative with SPSS 13.0. Results： The average operation time was 66.69 min. Average collodiaphyseal angle： uninjured side： 140.66 ± 9.08 degree; preoperative： 118.00± 15.49degree; peroperative： 135.16± 7.08 degree;postoperative： 137.51 ± 15.21 degree. There was significant difference between collodi- aphyseal angle of preoperative to three series else （P〈0.05）. There was no significant difference in collodiaphyseal angle of uninjured side; peroperative; postoperative. Three patients died, six were loss for follow-up, leaving 98 patients were followed up by 8.6 （ranging 3-22） months averagely. There was two cut-out. Three patients felt pain in femoral shaft after exercise, no fracture.96 case healed on the radio- graphs within the ranging 12-18 weeks. The Harris score at the final follow-up was average 78.5 scores （ranging 41-92）, good and excel- lent rate of 80.6%. Conclusions： The intramedullary nail InterTan is a very good choice to treat proximal femoral fractures.