股骨近端防旋髓内钉联合辅助钢板治疗股骨转子下骨折

Treatment of femoral subtrochanteric fractures with proximal femoral nail anti-rotation combined with auxiliary plate

目的探讨股骨近端防旋髓内钉(PFNA)联合辅助钢板治疗股骨转子下骨折的疗效。方法采用PFNA联合辅助钢板治疗21例股骨转子下不稳定骨折患者。记录术中出血量、手术时间、骨折复位质量、骨折愈合时间、负重情况以及术后并发症发生情况。采用改良Harris评分评价髋关节功能。结果患者均获得随访,时间13~25(19.9±3.3)个月。术中出血量180~300(214.8±36.6)ml,手术时间120~180(149.5±14.9)min。骨折复位质量:解剖复位10例,复位良好8例,复位不佳3例。患者拄双拐不负重下地活动时间为4~8(5.67±1.24)周。骨折均愈合,时间13~24(17.5±3.3)周。术后未出现骨折移位、内固定断裂、髋关节内翻畸形等并发症。术后1年改良Harris评分为82~120(103.4±10.6)分,其中优15例,良4例,可2例。末次随访时,15例可完全负重行走;4例轻度跛行,可不扶拐;2例明显跛行,需扶拐行走。结论采用PFNA联合辅助钢板治疗股骨转子下骨折可获得良好复位、坚强固定,患者能早期功能锻炼,减少了内固定失效、髋内翻、骨折不愈合等并发症的发生。

Objective To investigate the effect of the proximal femoral nail anti-rotation(PFNA)combined with auxiliary plate on femoral subtrochanteric fractures.Methods The 21 patients with unstable femoral subtrochanteric fractures were treated with PFNA combined with auxiliary plate.The intraoperative blood loss,operation time,fracture reduction quality,fracture healing time,weight-bearing condition and postoperative complications were recorded.The function of hip joint was evaluated with modified Harris score.Results All patients were followed up for 13~25(19.9±3.3)months.The intraoperative blood loss was 180~300(214.8±36.6)ml,and the operation time was 120~180(149.5±14.9)min.Fracture reduction quality:anatomical reduction was obtained in 10 cases,good reduction was obtained in 8 cases,poor in 3 cases.The time of walking with crutches without weight-bearing was 4~8(5.67±1.24)weeks.All fractures healed in 13~24(17.5±3.3)weeks.There were no complications such as fracture displacement,fracture of internal fixation and varus deformity of hip joint after operation.One year after operation,the modified Harris scores were 82~120(103.4±10.6)points,of which 15 cases were excellent,4 good,and 2 fair.At the last follow-up,15 patients could walk with full weight-bearing;4 cases could walk with mild lameness,without crutching;2 patients had obvious lameness and needed to walk with crutches.Conclusions In the treatment of femoral subtrochanteric fracture,PFNA combined with auxiliary plate can achieve good reduction and rigid fixation.Patients can do early functional exercise,and reduce the incidence of internal fixation failure,coxa vara,nonunion and other complications.