闭合复位PFNA内固定术在股骨粗隆间骨折治疗中的应用

Closed Reduction and Internal Fixation with PFNA for Intertrochanteric Femoral Fractures

目的探讨闭合复位防旋股骨近端髓内钉（PFNA）内固定术治疗股骨粗隆间骨折的疗效。方法对52例股骨粗隆间骨折患者（A1型17例,A2型26例,A3型9例）采取闭合复位PFNA内固定术治疗。观察患者的手术时间、术中出血量、并发症（切口感染、螺旋刀片切割、患肢短缩、髋内翻畸形、颈干角丢失、下肢深静脉血栓等）发生率及髋关节功能（Harris评分）的恢复情况。结果 52例患者手术时间为（56.3±7.3）min,术中出血量为（162.9±18.4）mL。术后随访8~27个月,所有患者切口均Ⅰ期愈合,未出现并发症,无死亡病例。按Harris评分,髋关节功能恢复优良率为94.23%。A3型患者手术时间长于A2、A1型患者,术中出血量多于A2、A1型患者,Harris评分低于A2、A1型患者（均P〈0.01）。A2型患者的手术时间长于A1型患者,术中出血量多于A1型患者（P〈0.01）。A1、A2、A3型患者骨折愈合时间比较差异无统计学意义（P〉0.05）。结论闭合复位PFNA内固定术治疗股骨粗隆间骨折手术时间短、术中出血少、术后并发症少及髋关节功能恢复好,疗效显著。

Objective To investigate the efficacy of closed reduction and internal fixation with proximal femoral nail antirotation（PFNA） in the treatment of intertrochanteric femoral fractures. Methods Fifty-two patients with intertrochanteric femoral fractures （type A1 in 17,type A2 in 26,and type A3 in 9） were given closed reduction and internal fixation with PFNA. Operation time, intraoperative blood loss, complications （wound infection, spiral blade cutting, ipsilateral limb shortening,coxa vara deformity,neck shaft-angle loss, deep vein thrombosis,etc. ）,and hip joint function were observed in all patients. Results The mean operation time and intraoperative blood loss were （56.3±7.3） minutes and （162.9±18.4） mL,respectively. After 8-27 months of follow-up,all patients had stage I healing without the occurrence of complications or death. Ac- cording to Harris scoring,the excellent and good rate of hip function recovery was 94. 23%. Com- pared with patients with type A1 or A2 intertrochanteric femoral fractures, operation time was prolonged,intraoperative blood loss was increased and Harris score was decreased in patients with type A3 intertrochanteric femoral fractures （P〈0.01）. Compared with patients with type A1 in- tertrochanteric femoral fractures,operation time was prolonged and intraoperative blood loss was increased in patients with type A2 intertrochanteric femoral fractures （P〈0.01）. There were nosignificant differences in fracture healing time among the three groups （P〉0.05）. Conclusion Closed reduction and internal fixation with PFNA can significantly shorten operation time, reduce intraoperative blood loss,decrease postoperative complications and promote hip function recovery in patients with intertrochanteric femoral fractures.