防旋髓内钉结合钢丝捆扎治疗股骨转子下长斜形骨折  

The treatment of subtrochanteric femur fractures using elongated proximal femoral nail anti- rotation combined with cerclage wire

作　　者：吴征杰[1] 杨宇[1] 刘远标[1] 刘卫明[1] 黄尚君 

机构地区：[1]广州中医药大学附属佛山市中医院,528000

出　　处：《中国矫形外科杂志》2014年第22期2024-2027,共4页Orthopedic Journal of China

摘　　要：[目的]探讨加长型防旋髓内钉（PFNA）结合小切口钢丝捆扎治疗股骨转子下长斜形骨折的临床疗效。[方法]回顾性分析2009年3月-2014年3月股骨转子下长斜形骨折患者的病例资料,共43例,其中23例加长型PFNA结合小切口钢丝捆扎治疗,20例采用动力髋螺钉（以下简称DHS）手术方法治疗,从手术时间、失血量和术后Harris功能评分比较两种手术方法的疗效。[结果]本组患者均获随访,时间最短8个月,最长2年,平均（12±1.5）个月。所有病例均骨性愈合,时间平均（15.7±3.5）周,行走恢复至术前水平,且无股骨头坏死、切割现象及髋内翻发生。各观察指标加长型PFNA组均优于DHS组,加长型PFNA组中,手术时间（64.8±5.5）min;术中出血量（241±12.5）ml。Harris髋关节功能评分评定（85±25）分,优良率93.9%;显著优于DHS组〔手术时间（80.6±2.3）min、术中出血量为（255±25.6）ml、Harris髋关节功能评分（70±15）分及优良率40.0%〕,P〈0.05。[结论]采用加长型PFNA结合小切口钢丝捆扎治疗股骨转子下长斜形骨折,疗效确切,且具有操作简单、出血少、创伤小、固定牢靠及并发症少等优点,效果优于DHS。[Objective]To investigate the clinical effectiveness of treating subtrochanteric femur fractures using elongated proximal femoral nail anti-rotation（ PFNA） combined with cerclage wire. [Method]From March 2009 to March 2014,there were 43 cases of longsegment subtrochanteric femur fractures. Twenty-three were treated using elongated PFNAII combined with cerclage wire,and 23 were treated using dynamic hip screw（ DHS）. The surgical approaches were compared. [Result]The PFNA with cerclage wire was superior to DHS. For those treated with PFNA,the mean operating time was 64. 8 ± 5. 5 min,and the mean blood loss was 241 ± 12. 5 ml. All patients were followed for a mean of 12 ± 1. 5 months; the longest follow- up was 2years and the shortest was 8 months. All patients had normal healing（ mean healing time,15. 7 ± 3. 5 weeks）. No complications,such as osteonecrosis,implant cut- out,orcoxa vara,occurred; however,2 patients experienced postoperative thigh pain until implant removal. According to the Harris criteria,19 cases were excellent,12 were good,and 2 were moderate. The rate of excellent result was 93. 9%. [Conclusion]The elongated PFNAII combined with cerclage wire was satisfactory for treating subtrochanteric femur fractures. This approach has the following advantages： easy,minimally invasive operation; less operative blood loss,strong fixation method,and fewer complications.

关 键 词：加长型PFNA 股骨转子下骨折 钢丝捆扎 髓内固定 DHS 

分 类 号：R687.3[医药卫生—骨科学]