加长型PFNA治疗股骨中上段长节段骨折  

Treatment of long-segment fracture in middle-up part of femoral with long proximal femoral nail antirotation

作　　者：林焱斌[1] 李仁斌[1] 熊国胜[1] 庄研[1] 熊圣仁[1] 黄显贵[1] 张怡元[1] 

机构地区：[1]厦门大学附属福州第二医院创伤骨科,福州350007

出　　处：《中华骨科杂志》2014年第10期1016-1023,共8页Chinese Journal of Orthopaedics

基　　金：福建省医学创新课题项目（2011-CXB-24）

摘　　要：目的：探讨加长型PFNA闭合复位微创穿钉固定治疗股骨中上段长节段骨折的疗效。方法回顾性分析2006年6月至2013年12月，采用加长型PFNA（320～380 mm）微创经皮固定及自体髂骨植骨治疗股骨中上段长节段骨折139例患者资料，男104例，女35例；年龄18～86岁，平均48.8岁；ⅠA型58例（41.73％，58/139），ⅠB型25例（17.99％，25/139），ⅠC型4例（2.88％，4/139），Ⅱ型28例（20.14％，28/139），ⅢA型12例（8.63％，12/139），ⅢB型5例（3.60％，5/139），Ⅳ型7例（5.04％，7/139）。受伤至手术时间为3 h至12 d，平均4.2 d。术后采用Harris髋关节功能评分评价术后疗效，使用视觉模拟评分（visual analogue scale, VAS）评价骨折术后疼痛。结果139例患者手术时间35～90 min，平均45 min；术中出血量30～200 ml，平均78.6 ml；除16例（ⅠC、ⅢB、Ⅳ型）严重长段粉碎骨折患者外，其余患者均在术后4～10 d下地扶拐行走。139例患者均获得完整随访，随访时间3～37个月，平均19个月。术后无一例出现感染、下肢静脉血栓、螺旋刀片切割股骨头。4例于术后2～4个月发生断钉，6例于术后1～10 d出现内旋畸形，均给予二次手术；5例于术后3天至6个月出现轻度外旋；8例于术后3～6个月出现髋内翻短缩畸形，均未进一步治疗。139例患者骨折均愈合，愈合时间为2.8～6.8个月，平均3.9个月。Harris髋关节功能评分为65～98分，平均92分，其中优108例、良22例、可8例、差1例，优良率93.53%（130/139）。术后VAS评分为0～6分，平均0.8分；其中不痛93例，轻度疼痛33例，中度疼痛13例，25例偶尔需服用非甾体类止痛药。结论加长型PFNA微创闭合复位或小切口感触辅助复位的髓内固定技术治疗股骨中上段长节段骨折术后骨折愈合率高、功能恢复快、并发症少，是一种符合生物力学的有效固定。Objective To investigate the effects of long proximal femoral nail antirotation （PFNA-long） in treating long-segment fracture in middle-up part of femoral. Methods From June 2006 to December 2013, we treated 139 cases long-segment fracture in middle-up part of femoral with long proximal femoral nail antirotation （PFNA, 320-380 mm） by minimally invasive per-cutaneous fixation and autogenous iliac bone graft. Data of 139 patients （104 male and female 35;ages 18 to 86 years, with an aver-age age of 48.8 years）. Type IA 58 cases （41.73%, 58/139）, type IB 25 cases （17.99%, 25/139）, type IC 4 cases （2.88%, 4/139）, type II 28 cases （20.14%, 28/139）, type IIIA 12 cases （8.63%, 12/139）, type IIIB in 5 cases （3.60%, 5/139）, type IV 7 cases （5.04%, 7/139）. The duration from injury to surgery was 3 hours to 12 days, with an average of 4.2 days. The postoperative follow-up was at 1, 2, 3, 6, 9, 12 months, and annually at least. The clinical efficacy was evaluated with Harris hip function score. The postoperative pain was evaluated with visual analogue scale （VAS）. Results The operative time of 139 cases was from 35 to 90 minutes, averaged 45 minutes and the blood loss during surgery averaged 78.6 ml （ranged from 30 to 200 ml）. All patients walked by walking aid appliance after 4 to 10 days postoperatively, apart from 16 cases with serious long grinding fracture. All patients had been followed up for 3 to 37 months （mean 19 months）. No complications, such as infection, lower limb vein infarction, cut-out and breakage of the implants, occurred. However, there were 4 patients with nail broken and 6 patients with hip internal rotation who were treated by secondary operation. There were 5 cases with slight hip external rotation and 8 cases with hip internal reverse-lamb shortening malformation. All fractures healed after 2.8-6.8 months （mean 3.9 months）. According to Harris criteria, the clini-cal results were best in 108 cases, better in 22 cases, good in 8 cases, and bad in

关 键 词：股骨骨折 骨折固定术 髓内 内固定器 

分 类 号：R687.3[医药卫生—骨科学]