PFNA微创治疗高龄股骨粗隆间骨折主钉植入方法探讨及早期临床疗效观察

PFNA Minimally Invasive Treatment of Elderly Patients with Intertrochanteric Fracture of the Main Screw Implantation and Early Clinical Observation

目的:探讨PFNA微创治疗股骨粗隆间骨折主钉植入方法及观察早期临床疗效。方法:回顾性分析2015年2-12月采用PFNA内固定治疗的48例老年股骨粗隆间骨折患者的病例资料,所有患者均采用偏距式三棱空心开口器定位主钉进针点满意后打入导丝植钉操作。结果:48例患者中未出现切口感染及术中植入主钉时导致大转子骨折。其中3例患者出现螺旋刀片移位致髋内翻但未切除股骨头,但是患者无症状,无需特殊处理。1例患者术后出现螺旋刀片切除股骨头,给予患者取出髓内钉,改为股骨头置换手术成功处理。1例患者在植入髓内钉时出现股骨远端骨折,予以更换加长PFNA髓内钉处理后骨折愈合。结论:PFNA微创治疗高龄股骨粗隆间骨折,主钉植入方法非常重要,术中采用偏距三棱空心开口器定位主钉进针点满意后打入导丝植钉操作简单,准确性好,避免导丝穿入内侧及植入主钉时导致大粗隆骨折;PFNA整体稳定性好,固定可靠,早期临床效果满意。

Objective：To investigate the PFNA minimally invasive treatment of intertrochanteric fractures of the main screw implantation method and observation of early clinical efficacy.Method：From February 2015 to December 2015,the clinical data of 48 patients with intertrochanteric fractures treated with PFNA in our hospital were retrospectively analyzed.All patients used offset type triangular hollow guide wire implant operation after opener position of the main nail into the needle point satisfactory.Result：Among 48 patients,there were no incision infection and major trochanteric fractures during implantation occured.3 patients screw blade shifted made coxa vara,but the patient had no symptoms and special treatment;1 patient spiral knife blade cut femoral head,the patient was removed intramedullary nail and treated with femoral head replacement surgery successfully.1 patient distal femoral fractures at implant intramedullary nailing,and fracture healed after replaced for lengthened PFNA intramedullary nail.Conclusion：For PFNA minimally invasive treatment of intertrochanteric fractures,the main nail implantation method is very important,using guide wire insertion offset triangular hollow opening device has the advantages of simple operation,into the position of the main nail needle points satisfied with good accuracy,can avoid trochanter fracture caused by wire medial penetration and nail implantation;PFNA has good overall stability and reliable fixation,early stage clinical effect is satisfactory.