亚洲型防旋股骨近端髓内钉微创修复股骨转子间骨折:可为高龄患者首选

Proximal femoral nail antirotation-Asia for trochanteric femoral fractures: the first choice for the elderly patients

背景:当前已知多种髓内固定物适用于股骨转子间骨折,PFNA-Ⅱ作为新型髓内固定物的代表,治疗各型转子间骨折具有其独特优势。目的:探讨亚洲型防旋股骨近端髓内钉治疗股骨转子间骨折的内固定质量。方法:回顾性分析亚洲型防旋股骨近端髓内钉治疗39例股骨转子间骨折患者,按AO分型为A1型(n=11)、A2型(n=20),A3型(n=8),分析不同类型骨折内固定持续时间、内固定过程中出血量及近端刀口长度等,髋关节Harries功能评分评价其临床疗效。结果与结论:39例患者均获随访,随访时间12-24个月,平均16.5个月。手术时间51-120 min,平均77.1 min;术中出血量39-185 mL,平均85.41 mL。其中A1、A2型患者各项指标好于A3型(P<0.05),差异有显著性意义,但两组间比较差异无显著性意义。内固定后9个月髋关节Harries功能评分61-95分,优16例,良16例,中6例,差1例,优良率82.1%,其中A1型优良率最好、A2型次之,A3型最差,3组间比较差异有显著性意义(P<0.05)。结果证明亚洲型防旋股骨近端髓内钉适用于全部类型的股骨转子间骨折,对伴有骨质疏松的高龄患者,可作为首选。对于类型复杂的骨折,术中应注意恢复内侧结构的完整性,并联合移动式C型臂X光机拼接技术实时评价复位效果,有助于提高内固定质量。

BACKGROUND：At present, there have been several intramedulary nail internal fixations being suited for the treatment of intertrochanteric fractures. PFNA-II, as the representative of new intramedulary nail internal fixations, has its unique advantages for the treatment of various types of intertrochanteric fractures. OBJECTIVE：To evaluate the clinical effect and operative skils of proximal femoral nail antirotation-Asia in treatment of intertrochanteric fractures. METHODS： A total of 39 patients with intertrochanteric fractures undergoing proximal femoral nail antirotation-Asia were retrospectively analyzed. According to AO classification, there were type A1 （n=11）, type A2 （n=20） and type A3 （n=8）. Duration of fixation, blood loss during fixation and proximal incision length were analyzed. Harris hip scores were used for the evaluation of clinical effect. RESULTS AND CONCLUSION：A total of 39 patients were folowed up for 12 to 24 months, averagely 16.5 months. The average operation time was 77.1 minutes （ranged from 51 to 120 minutes） and the mean intra-operative blood loss was 85.41 mL （ranged from 39 to 185 mL）. Various indexes in A1 and A2 patients were better than A3 patients （P 〈 0.05）. However, no significant difference was detected between two groups. Harris hip score at 9 months postoperatively was ranged from 61 to 95. According to Harris hip score evaluation system,16 patients reached an excelent result, 16 good, 6 average and 1 poor, with the excelent and good rate of 82.1%. The excelent and good rate was best in type A1, folowed by type A2, and was poorest in the type A3.＆nbsp;Significant differences in excelent and good rate were detectable among three groups （P〈 0.05）. Results confirmed that proximal femoral nail antirotation-Asia is suitable for al types of trochanteric fractures. It is the first choice for elderly patients with osteoporosis. For complicated fracture, integrity of inner structure should be restored during operation. Mobile C-arm X-ray machine stitching technique can be used to evaluate reduction effects, which can be helpful to elevate the quality of fixation.