加长PFNA结合钛缆环扎术治疗股骨转子下长斜形及螺旋形骨折疗效观察  

Application of Long Proximal Femoral Nails Antirotation and Cerclage Cables in Long Oblique and Spiral Fractures in the Subtrochanteric Area of Proximal Femur

作　　者：肖飞[1] 王俊文[1] 焦竞[1] 黄玉成[1] 

机构地区：[1]武汉市普爱医院骨科,湖北武汉430033

出　　处：《武汉大学学报（医学版）》2014年第1期140-142,151,共4页Medical Journal of Wuhan University

摘　　要：目的:探讨应用加长亚洲型股骨近端髓内钉(PFNA)结合钛缆环扎术治疗股骨转子下长斜形及螺旋形骨折的方法及疗效。方法:2010年8月至2013年2月,收治22例股骨转子下长斜形及螺旋形骨折患者,按Zickel分型均为1B型;其中男16例,女6例;年龄24-78岁,平均66.3岁。均在C型臂X线机透视下采用加长PFNA结合钛缆环扎术治疗,术后髋关节功能采用Harris评分。结果:所有患者均获得随访,随访时间6-36个月,平均20.2个月。骨折全部愈合,愈合时间为9-16周,平均12.4周。均未出现感染、髋内翻畸形、下肢外旋及短缩畸形、螺旋刀片切割股骨头、股骨干骨折、内固定失效及延迟骨愈合等并发症。患者按Harris髋关节功能评分标准优13例,良7例,可2例,优良率为90.9%。结论:PFNA结合钛缆环扎术治疗股骨转子下长斜形及螺旋形骨折具有操作简单、创伤小、内固定牢靠、可早期功能锻炼及术后并发症少等优点,临床疗效良好。Objective： To evaluate the clinical effect of long proximal femoral nails antirotation （PFNA） and cerclage cables in long oblique and spiral fractures in the subtrochanteric area of proximal fe- mur. Methods： Under the guidance of fluoroscopy, all the 22 patients with long oblique and spiral fractures in the subtrochanteric area of the proximal femur were treated with long PFNA and cer- clage cables from August 2010 to February 2013 in our unit. They were 16 males and 6 females, with an average age of 66.3 （24 to 78） years. According to Zickel classification, there were all type lB. This method involved reduction of the fracture through an open approach, and then em- ployed cerclage cables to stabilize the fracture in an anatomical position before finally inserting a long proximal femoral nail. Postoperative hip functions were evaluated by Harris system. Results. The patients were followed up for 20.2 （6 to 36） months averagely. Fracture union was achieved in all patients with a mean healing time of 12.4 （9 to 16） weeks. The postoperative Har- ris score was excellent in 13 cases, good in 7 and fair in 2. The total excellent to good rate was 90.9%. No infection, coxa vara, external rotation or shortening deformity, cut-out, fracture of femoral shaft, internal fixation failure, or bone nonunion occurred. Conclusion： The long PFNA and cerclage cables fixation has advantages of little osseous destruction, simple operation, less blood loss, anti-rotation, stable fixation and few postoperative complications. It is an effective treatment for long oblique and spiral fractures in the subtrochanteric area of the proximal femur.

关 键 词：股骨骨折 骨折内固定术 髓内 环扎术 

分 类 号：R683.42[医药卫生—骨科学]