老年股骨转子间骨折股骨近端抗旋髓内钉内固定的手术技巧  

TECHNICAL TIPS AND SKILLS FOR PROXIMAL FEMORAL NAIL ANTI-ROTATION(PFNA)IN THE TREATMENT OF GERIATRIC INTERTROCHANTERIC HIP FRACTURES

作　　者：司刚[1] 刘磊[1] 蒋建农[1] 莫渊[1] 史智伟[1] 周鸣[1] 

机构地区：[1]江苏大学附属宜兴市人民医院骨科,江苏省宜兴市214200

出　　处：《中国煤炭工业医学杂志》2013年第9期1501-1503,共3页Chinese Journal of Coal Industry Medicine

摘　　要：目的随着股骨近端抗旋髓内钉(proximal femoral nail anti-rotation,PFNA)在老年股骨转子间骨折治疗中的广泛应用,临床上出现插钉困难、固定不满意的病例逐渐增多。为取得满意疗效,本文着重探讨使用PFNA治疗老年股骨转子间骨折的手术技巧。方法通过总结自身经验并复习文献资料,总结出确保手术成功的10条经验。结果 10条经验:①满意的体位摆放;②良好的骨折复位;③股骨大转子顶点开口应略偏向顶点内侧;④近端高速扩髓;⑤主钉徒手插入;⑥确保抗螺旋刀片在股骨头中的理想位置;⑦TAD确定抗螺旋刀片在股骨头中的深度;⑧谨防股骨干前弓;⑨避免骨折端的分离;⑩正确把握骨折线至锁定钉孔的距离。结论正确掌握PFNA的结构特点与手术技巧,有利于提高插钉成功率与固定质量,确保手术疗效。Objective To investigate the technical tips and skills of proximal femoral nail anti- rotation in the treatment of geriatric intertrochanteric hip fractures. Methods Ten tips regarding successful nailing and stable fixation were gathered by summary our own experiences and lessons, reviewing related literatures. Results These ten tips included correct patient position in fracture table, perfect fracture reduction, medial shift of entry point from the exact trochanteric tip, high speed reaming, hand insertion of nail without hammer blow, good position of helical blade in femoral head, using TAD to control the depth of helical blade in femoral head,＊ awareness of the femoral anterior cortex, management of the fracture separation, and secure distance from fracture part to the distal locking screw. Conclusion Paying attention to the struc- ture characteristics of PFNA and operation skills can improve the nailing success rate and fixation quality. And it＇s good for curative effect.

关 键 词：骨折 股骨转子间 髓内钉内固定 股骨近端抗旋髓内钉 手术技巧 

分 类 号：R683.42[医药卫生—骨科学]