防旋股骨近端髓内钉治疗股骨粗隆间骨折98例体会

Proximal femur nail antirotation internal fixation in the treatment of intertrochanteric femoral fractures

目的总结防旋股骨近端髓内钉(proximal femur nail antirotation,PFNA)微创内固定术治疗股骨粗隆间骨折的方法和临床疗效。方法 2007年5月～2011年1月,采用PFNA治疗股骨粗隆间骨折98例。男34例,女64例,平均76岁(59～93岁)。致伤原因:车祸伤10例,摔伤88例。均为闭合性骨折。根据Evans分型,Ⅰ型22例,Ⅱ型42例,Ⅲ型22例,Ⅳ型12例。伤后至手术时间为6 h～5 d。对患者进行手术后随访,评估患者的恢复情况。结果术后切口均达I/甲级愈合。患者均获随访,随访时间为术后6周、3个月、6个月、1年。术后骨折均达临床愈合,愈合时间为12～20周,平均16周。无内固定失败及松动,无螺钉切割股骨头及短缩畸形等并发症发生。患者髋关节功能按Harris评分标准:优75例,良18例,优良率94.9%。结论利用PFNA治疗股骨粗隆间骨折是一个可行的选择,并且可以达到优良的骨折愈合及有限的并发症。

Objective： To summarize the clinical application of proximal femur nail antirotation（PFNA） internal fixation in the treatment of intertrochanteric fractures and to evaluate its clinical effects.Methods： From May 2007 to January 2011,98 patients with intertrochanteric fractures were treated with indirect reduction and PFNA internal fixation,34 males and 64 females,aged 59-93 years old（76 on average）.Among them,the fractures were caused by traffic accidents in 10 cases,and by falling in 88 cases.All fractures were closed ones.According to the Evans classification,there was grade I in 22 patients,grade II in 42 patients,grade III in 22 patients,and grade Ⅳ in 12 patients.The time between fractures and operation was from 6 hours to 5 days.Patients were revisited at six weeks,three months,six months and one year after operation.The progress of healing,as well as the occurrence of complications,was recorded.Results： All incisions obtained healing by first intention.All patients were followed up for 10-18 months（13 months on average）.All fractures reached clinical healing,and the healing time was 12-20 weeks（16 weeks on average）.There was no delayed fracture healing,nonunion,infection and internal fixation failure.No complications such as ＂cut-out＂ of the femoral head screw,crispatura deformity and internal fixation loosening were found.In the function of the hip joint according to the Harris scoring,75 cases were excellent,18 good,and the choiceness rate was 94.9%.Conclusion： The PFNA can be a feasible alternative to the treatment of intertrochanteric fractures.Treatment with the a PFNA can provide good-to-excellent healing for intertrochanteric fractures,with a limited occurrence of complications.