加长型股骨近端防旋髓内钉治疗股骨中上长节段骨折

Extended Proximal Femoral Intramedullary Nail for the Treatment of Middle and Proximal Femoral Fractures

目的观察加长型股骨近端防旋髓内钉(加长型PFNA)内固定治疗股骨中上长节段骨折的临床疗效。方法回顾性分析2012年1月至2015年7月我院收治且获得随访的25例股骨中上长节段骨折患者的资料,男17例,女8例;年龄36~85岁,平均56.3岁;所有患者均为单侧股骨闭合性骨折,受伤至手术间隔为1d^9d,平均4.7 d。术后第l、2、3、6、9、12个月门诊定期随访。采用Harris髋关节功能评分标准评价临床疗效。结果本组患者术中出血量为55~430mL,平均108.3mL,手术时间为52~117min,平均63min;所有患者术后5~21d下地扶拐行走。25例患者获得完整随访,骨折愈合时间为2.5~6.5个月,平均3.8个月。末次随访时按Harris髋关节功能评分标准:优19例,良5例,中1例,优良率96%(24,25)。所有患者均未出现感染及骨折不愈合,2例出现轻度髋内翻短缩畸形,3例出现下肢肌间静脉血栓,经药物治疗,血栓未加重。结论加长型PFNA可以同时对股骨转子部及股骨干骨折进行固定,具有出血少、固定可靠、生物力学特性好、功能恢复快、并发症少等优点,是股骨中上段长节段骨折的微创而有效的治疗方法。

Objective To observe the clinical effect of extended proximal femoral intramedullary nail（ extended PFNA） for the treatment of middle and proximal femoral fractures. Methods 25 cases of patients with middle and proximal femoral fractures that were treated and followed up in our hospital from January 2012 to July 2015 were retrospectively analyzed, 17 cases of male,8 cases of female ; age ranged from 36 to 85 years old, average 56. 3 years old; all patients were unilateral closed femoral fracture, time interval from injury to surgery is 1 d N 9d, average 4. 7d. The patients were followed up regularly at 1,2,3,6,9 and 12 months after surgery at outpatient department. Harris hip function score was used to evaluate the clinical efficacy. Results The intraoperative bleeding volume was 55 ~ 430 ml, average 108.3 ml, operation time was 52 - 117 min, average 63 min; all patients could walk with stick 5 ~ 21d after the operation. 25 patients were followed up completely, the fracture healing time was 2. 5 ~ 6. 5 months, average 3.8 months. At the last follow-up, according to the Harris hip function scoring criteria, 19 cases were excellent,5 cases were good, 1 case was middle, the excellent and good rate was 96% （24,25）. No infection or nonunion occurred in all the patients,2 cases of mild coxa vara shortened deformity,3 cases with lower extremity intermuscular vein thrombosis and the thrombosis was not aggravated by medication. Conclusion Extended PFNA can fix the peritrochanteric fracture and Femoral shaft fracture at the same time, it has advantages such as less bleeding, reliable fixation, good biomechanical properties, fast function recovery and less complications, and it is the treatment of middle and proximal femoral fractures with minimally invasive and effective.