老年股骨粗隆间骨折PFNA内固定术后失效的翻修方法及效果分析  

Analysis of failure causes for elderly femoral intertrochanteric fractures by proximal femoral nail anti-rotation

作　　者：茹江英[1] 丛宇[2] 仓海斌[1] 杨乐[1] 

机构地区：[1]武警江苏省总队医院骨科,江苏省扬州市225003 [2]南京军区南京总医院骨科

出　　处：《中国骨与关节损伤杂志》2014年第2期129-131,共3页Chinese Journal of Bone and Joint Injury

基　　金：国家自然科学基金(81000814)

摘　　要：目的探讨老年股骨粗隆间骨折采用股骨近端防旋髓内钉（PFNA）内固定术后发生内固定失败的原因、翻修方法及效果分析。方法应用PFNA内固定治疗的158例老年股骨粗隆间骨折中11例术后发生螺旋刀片切出、内固定松动退出、主钉断裂，4例行人工全髋关节置换术（THR）翻修，7例行人工股骨头置换术（AFHR）翻修；5例股骨粗隆采用钛缆钢板系统（CPS）固定，6例予以1或2股钢丝（SW）捆扎固定。结果11例翻修术后平均随访26．9（13～51）个月，无切口深部感染、假体松动、脱出及断裂、假体周围骨折、骨水泥界面出现透亮区等并发症发生。术后1年髋关节功能Harris评分平均83．5（70～92）分，其中优6例，良3例，可2例。结论扩髓前股骨近端骨折块复位不良、进钉点选择与螺旋刀片放置位置不当、远端锁钉应用不规范与锁定后骨折端分离、PFNA设计的缺陷与手术指征把握不严格、术后康复计划不合理等因素可能是老年股骨粗隆间骨折PFNA内固定术后发生内固定失败的主要原因；一旦发生内固定失败，选用恰当的翻修手术仍可获得满意疗效。Objective To investigate the failure causes for elderly femoral intertrochanteric fractures by proximal femoral nail anti-rotation （PFNA）. Methods A total of 158 cases of elderly femoral intertrochanteric fractures were treated with PFNA. Of which, 11 cases had such complications as cut-out, loosening, prolapse and rupture of internal fixators postoperatively. In rebuilding surgery, 4 cases were reconstructed with total hip replacement （THR） and 7 cases with artificial femoral head replacement （AFHR）, while 5 cases were combined with fixation of cable plating system （CPS） and 6 cases with that of steel wire （SW）. Results All revision patients were followed up for an average of 26.9 months （range, 13-51 months）. At the last follow-up, such complications as deep infeetion of incision, prosthesis loosening, prolapse, breakage, peri-prosthetie fracture, appearing lucent area in the eement interface didn＇t occur. The average Hart＇is score of the affected hip one year after surgery was 83.6 points （range, 70-92 points）, the results were excellent in 6 cases, good in 3 cases, fair in 2 cases. Conclusion Sueh factors as malreduction of proximal fracture before enlarging marrow, improper location of entering-nail point and spiral blade, non-standard application of distant lockpin, separation of fracture end after lockedup, designing defect of PFNA and less striet selection of indication, irrationality of rehabilitation programme postoperatively ere might be main eauses for elderly femoral intertrochanteric fractures with PFNA, so it is a key for affective avoidance of fixation failure and obtaining of satisfactory effect of treatment to reduce the iatrogenic factors and increase the compliance of patients.

关 键 词：股骨粗隆间骨折 老年 股骨近端防旋髓内钉 内固定失败 

分 类 号：R687.3[医药卫生—骨科学]