亚洲型股骨近端防旋髓内钉术后影像学测量  

Postoperative radiological measurement on proximal protrusion of PFNA-Ⅱ

作　　者：熊良平[1] 张世民[2] 

机构地区：[1]浙江省建德市第一人民医院骨科,浙江建德311600 [2]上海市杨浦区中心医院骨科,上海200090

出　　处：《同济大学学报（医学版）》2013年第4期72-75,共4页Journal of Tongji University(Medical Science)

摘　　要：目的从术后影像学角度评价亚洲型股骨近端防旋髓内钉(PFNA-Ⅱ)钉尾突出高度与大转子的适配性。方法回顾性分析2010年7月至2010年12月,采用PFNA-Ⅱ治疗的51例老年股骨转子间骨折,术后2周正位X片,以大转子弧线为基准测量主钉钉尾外侧突出高度、正位Parker比例、正位尖顶距、正位股距尖顶距。结果 87.8%主钉钉尾突出大转子弧线,平均突出高度为(6.25±4.67)mm[男(4.84±4.38)mm,女(7.09±4.70)mm],突出高度与Parker比例呈正相关,Parker比例大于50组比小于50组的平均突出高度高3 mm。结论 PFNA-Ⅱ与国人股骨近端形态仍不能完全适配,存在主钉钉尾突出股骨大转子的问题。将螺旋刀片置于股骨头颈的中下1/3,可减小钉尾突出高度。Objective To quantitatively measure the proximal protrusion of Asian proximal femur intramedullary nail anti-rotation （PFNA-Ⅱ） on the plain films for evaluating the match-up between PFNA-Ⅱ and the shape of great trochanter. Methods Clinical data of 51 elderly patients with intertrochanteric fractures treated with PFNA-Ⅱ from July 2010 to December 2010 were retrospectively reviewed. On the X-ray films taken 2 weeks after operation the lateral prominent height, anteroposterior Parker ratio, anteroposterior tip-apex distance （TAD） and anteroposterior calcar tipapex distance （CalTAD） were measured. Results Proximal PFNA-Ⅱ protruded from the great trochanter in the majority cases （ 87.8 % ） with an average protrusion height of （ 6.25 ±4.67） mm [（4.84 ± 4.38 ） mm for males, （7.09 ±4.70） mm for females ]. Heights in Parker-ratio-greater-than- 50 group were greater than Parker-ratio-less-than-50 group with a mean difference of 3 mm. Conclusion PFNA-Ⅱ seems not completely match up the proximal femur shape of Asian population. If the helical screw is placed partially below femoral head, it may reduce the prominent height without increasing the rate of lag screw cut-out.

关 键 词：股骨近端骨折 亚洲型股骨近端防旋髓内钉 尖顶距 Parker比例 

分 类 号：R68[医药卫生—骨科学]