股骨近端防旋髓内钉在股骨转子间骨折内固定失效翻修中的应用  

Proximal femoral nail antirotation for salvage of failed internal fixation of intertrochanteric hip fracture

作　　者：独行业[1] 周正明[1] 殷小军[1] 顾家烨[1] 徐耀增[2] 

机构地区：[1]江阴市人民医院骨科,214400 [2]苏州大学附属第一医院骨科

出　　处：《中华创伤杂志》2015年第1期45-49,共5页Chinese Journal of Trauma

摘　　要：目的 评价股骨转子间骨折内固定失效后行股骨近端防旋髓内钉（PFNA）内固定加自体髂骨植骨术的疗效. 方法 选择2007年1月-2012年6月采用切开复位PFNA内固定加自体髂骨植骨术治疗初始内固定失效的股骨转子间骨折患者21例,其中男9例,女12例;年龄27 ～ 76岁,平均54岁.Ⅰ期失效的内固定包括动力髋螺钉（DHS）7例,股骨近端锁定钢板（LPFP）8例,Gamma钉2例,股骨近端髓内钉（PFN）2例,国产重建钉2例. 结果 手术时间平均150 min（100～240 min）,出血量平均800 ml（400 ～2 000 ml）,术中无严重并发症.随访6～ 66个月,平均26个月,所有患者均获得骨愈合,平均愈合时间4个月（3～8个月）.Harris髋关节功能评分：术前为36 ～ 48分[（42.1±3.2）分],末次随访为62 ～ 94分[（87.2±3.8）分]（P＜0.05）.X线片测量颈干角平均130°时（110°～ 142°）,未发现髋关节退行性改变及股骨头无菌性坏死表现.结论 对于活动能力强、股骨近端残留骨量多、髋关节无严重损害的股骨转子间骨折内固定失效患者,PFNA内固定加自体髂骨植骨术可获得满意疗效.Objective To evaluate the effect of proximal femoral nail antirotation （PFNA） with autogenous bone grafting for salvage of failed internal fixation of intertrochanteric hip fracture.Methods Between January 2007 and June 2012,21 cases of intertrochanteric fractures who had failed internal fixation initially were treated with revision open reduction and PFNA internal fixation and autogenous bone grafting.There were 9 men and 12 women with the mean age of 54 years （range,27-76 years）.In the initially failed internal fixation,dynamic hip screw （DHS） was used in 7 cases,locking proximal femoral plate （LPFP） in 8 cases,Gamma nail in 2 cases,proximal femoral nail （PFN） in 2 cases and home-made reconstruction nail in 2 cases.Results Mean operation time was 150 minutes （range,100-240 minutes） and mean blood loss was 800 ml （range,400-2,000 ml）.There were no serious complications during operation.Mean follow-up was 26 months （range,6-66 months）.Bone healing was achieved at mean 4 months （range,3-8 months） in all cases.Harris hip score was （42.1 ±3.2） points （range,36-48 points） before operation and （87.2 ± 3.8） points （range,62-94 points） at the final follow-up,with significant improvement in hip function （P 〈 0.05）.At the final follow-up,no avascular necrosis of the femoral head or hip degeneration occurred and mean neck-shaft angle was 130° （range,110°-142°）.Conclusions Once the fracture patients with strong ability of action,massive proximal femoral residuals,and non-serious hip injury,revision PFNA internal fixation with autogenous bone grafting is effective.Complete preoperative evaluation and attention to specific technical details may improve success rate and reduce complications.

关 键 词：髋骨折 骨折 不愈合 股骨近端髓内钉 

分 类 号：R687.3[医药卫生—骨科学]