股骨近端螺旋刀片抗旋髓内钉治疗股骨转子间骨折的并发症原因分析

Complications of intertrochanteric fractures treated with proximal femoral nail anti-rotation(PFNA) system

背景:股骨近端螺旋刀片抗旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗股骨转子间骨折虽然能取得良好的疗效,但术中及术后仍存在较多并发症。目的:分析PFNA治疗股骨转子间骨折的主要并发症及其原因。方法:2006年6月至2011年6月收治股骨转子间骨折229例,男132例,女97例;年龄48～103岁,平均65.5岁;右侧127例,左侧102例;骨折根据AO分型。入院至手术时间3～16d,平均5d;住院时间4～23d,平均13.5d。术后定期随访,行X线片检查及采用Harris评分评估其疗效,记录术中及术后并发症。结果:手术时间为19～112min,平均39.8min;出血量为20～250ml,平均47ml;复位质量:好137例,可78例,差14例;187例(81.6%)的尖顶距<25mm,42例25mm。颈干角为125°～148°,平均135.7°。术中并发症包括股骨干骨折3例;股骨大转子劈裂骨折12例。随访时间18～28个月,平均22.4个月。术后早期并发症包括:褥疮2例;伤口愈合不佳6例。术后晚期并发症包括内翻畸形5例;髋部外侧疼痛4例;大腿中部疼痛11例;螺旋刀片切割2例;股骨短缩9例;断钉2例;螺旋刀片退钉7例。Harris评分67～96分,平均83.8分,优152例,良48例,中23例,差6例。无一例出现异位骨化、肢静脉栓塞、深部感染等。结论:采用PFNA治疗股骨转子间骨折疗效肯定,但术中和术后并发症较多,仔细分析各种主要并发症发生的原因及危险因素,以提高临床疗效。

Background： Although the therapeutic effects are satisfactory by proximal femoral nail anti-rotation （PFNA） in treatment of intertrochanteric fractures, there are still intraoperative and postoperative complications. Objective： The purpose of the study is to investigate the complications of the PFNA system in treatment of intertrochanteric fractures. Methods： From June 2006 to June 2011, 229 patients with intertrochanteric fracture underwent osteosynthesis with PFNA. There were 132 males and 97 females with a mean age of 65.5 years （range 48 to 103 years）. The fractures affected 127 right hips and 102 left hips. The fractures were classified according to the AO system. The mean duration from injury to surgery was 5d （range 3 to 16 d）. The mean hospital stay was 13.5 d （range 4 to 23 d）. Surgical results were assessed clinically （Harris hip score） and radiographically. Perioperative and postoperative complications were recorded. Results： The mean operation time was 39.8 min （range 19 to 112 min） and the mean blood loss was 47ml （range 20 to 250 ml）. Reduction was poor in 14 patients, acceptable in 78, and good in 137. The tip-apex distance was less than 25 mm in 187 patients, and 25 mm and more than 25 mm in 42 patients. The mean neck-shaft angle was 135.7°（range 125°to 148°）. During the surgery, femoral shaft fracture occurred in 3 patients, and greater trochanter fracture occurred in 12 patients. Post- operative complications included pressure sore in 2 cases, poor healing in 6, secondary varus in 5, lateral hip pain in 4, thigh pain in 11, screw cut-out in 2, femoral shortness in 9, nail breakage in 2, and screw lateral displacement in 7. The mean Har- ris hip score was 83.8 （range 67 to 96）. The outcomes were excellent in 152 patients, good in 48, fair in 23, and poor in 6. No heterotopic ossification, venous embolism and deep infection occurred. The mean follow-up lasted for 22.4 months （range 18-28 months）. Conclusions： The clinical outcome of PFNA is good in treating intertrochanteric fractures, but the complications should be highly considered.