PFNA结合克氏针微创闭合复位治疗老年股骨反转子间骨折

Closed Replacement and Kirchner Assisted Proximal Femoral Nail Anti-rotation in Treatment of Reversal Intertrochanteric Fracture

目的分析股骨近端防旋髓内钉(PFNA)结合克氏针微创闭合复位治疗老年人股骨反转子间骨折的临床疗效及手术技巧。方法 2015年6月~2017年9月,术中C臂X线机透视下,采用牵引床牵引、克氏针辅助微创复位,PFNA内固定术治疗我院老年股骨反转子间骨折29例,骨折根据AO分型为A3.1型13例、A3.3型16例。患者均在术后1,2,3,6,12个月定期复查X线片并行功能检查,临床评价行髋关节Harris评分标准。结果本组术中通过闭合牵引床牵引、克氏针辅助复位,骨折端均得到良好复位,手术过程顺利。术后29例患者均获得12个月随访,无感染、脂肪栓、深静脉血栓形成、骨折不愈合、髋内翻及旋转畸形等并发症发生,无死亡病例。根据Harris标准评分,优20例,良7例,中2例,优良率93.1%.结论克氏针辅助利于股骨逆子间骨折的闭合复位,股骨近端髓内钉固定治疗股骨逆转子间骨折、创伤小、易于操作,有利于骨折复位以及保护髓外血运,疗效可靠。

Objective To investigate the surgical techniques and clinical efficacy of the closed replacement and kirchner assisted proximal femoral nail anti-rotation in the treatment of reversal intertrochanteric fracture. A retrospective study was conducted to analyse the replacement skills and clinical data of 29 patients who had been treated for reversal intertrochanteric fracture with Kirchner assisted proximal femoral nail anti-rotation in our department between June 2015 and September 2017. According to the AO classification,there were 13 cases of type A3. 1,16 cases of type A3. 3. The Harris scores after operation were analysed. Results No infection,fat embolism,deep vein thrombosis,nonunion and the rotation deformity and rotation of the hip occurred. No patients were dead. All patients were followed up for12 months. According to the Harris criterion,20 cases were rated as excellent,7 good and 2 fair. All patients got good replacement. Conclusion The closed replacement and Kirchner assisted proximal femoral nail anti-rotation are easy to operate and it is useful to the replacement of fractures and the protection of extramedullary blood supply. They are advisable choices for the treatment of reversal intertrochanteric fracture.