加长型PFN或Gamma钉治疗股骨转子下骨折  

Treatment of subtrochanteric fracture with long PFN or gamma nail

作　　者：蒋雷生[1] 王伟[1] 戴力扬[1] 

机构地区：[1]上海第二医科大学附属新华医院骨科,上海200092

出　　处：《创伤外科杂志》2005年第6期411-414,共4页Journal of Traumatic Surgery

摘　　要：目的评价股骨转子下骨折应用加长型股骨近端髓内钉(PFN)或伽码(gamma)钉内固定的治疗效果。方法49例股骨转子下骨折采用加长型PFN或gamma钉内固定治疗,C臂机透视下牵引复位,必要时骨折断端小切口切开复位,钢丝环扎或钢缆捆绑。结果除1例发生骨折延迟愈合外,其余48例骨折全部无障碍愈合。术后半年随访时所有病例功能恢复良好,闭合复位成功32例,小切口钢丝环扎或钢缆捆绑复位固定17例。手术时间平均46分钟。18例SeinsheimerⅡ型骨折未作远端交锁,其余病例全部在远端用1枚螺栓做静力交锁固定。无螺钉切割移位或内植物断裂等并发症。结论股骨转子下骨折采用加长型PFN或gam-ma钉内固定,手术创伤小,骨折愈合率高,符合生物力学要求。其技术要求高,应避免并发症发生。Objective To evaluate the clinical outeome of subtrochanteric fractures fixed with long PFN or gamma nail.Methods Forty-nine cases of traumatie subtrchanteric fractures were intramedullary fixed with a long PFN or a long gamma nail.Recuction was performaed under traction and C-arm fluoroxscopy on fracture table,with cerelage wiring or cable bandage through a mini incision when necessary.Results All the 49 cases of subtrochanteric fractures hcaled uncventfully except 1 case of delayed union.Walking and squatting ability was complitely restored in each case at follow-up examination of 6 months postoperatively.Among them,32 fractures were successfully reduced with traction on a fracture table under fluoroscopy,but cerelage wiring or calble bandgage through a mini incision was needed in the other 17 cases.The average opreative time was 46minutes,with 21 minutes being the quickest one and 98 minutes being the lougest one.Eighteen Scinsheimer type Ⅱ fractures were left unlocked distally,and static distal interlocking with 1 bolt was carrid out in the other 31 cases.No complications such as cut-out or breakage of the implants was encountered .Couclusion Long PFN or long gamma nail is a reliable implant for subtroehanteric fractures,leading to high rate of bone union and minimal soft tissue damage.With the biological and biomechanical advantages of intramedullary fixation,the operation is also technically demanding.Grqdual learning and great putience is mecded in order to make this method be truly mini-invasive.

关 键 词：股骨骨折 股骨转子 内固定 

分 类 号：R683.42[医药卫生—骨科学]