股骨近端防旋髓内钉治疗不稳定股骨转子间骨折  

Treatment of unstable femoral intertrochanteric fractures with proximal femoral nail antirotation

作　　者：陈红卫[1] 张根福[1] 赵胜春[1] 吴国林[1] 赵钢生[1] 潘骏[2] 

机构地区：[1]温州医学院附属义乌医院,义乌市中心医院骨科,322000 [2]温州医学院第二附属医院骨科

出　　处：《浙江医学》2015年第1期22-24,29,共4页Zhejiang Medical Journal

基　　金：义乌市科技计划项目(11-3-03);浙江省卫计委高层次人才项目(2004-108)

摘　　要：目的：探讨采用股骨近端防旋髓内钉（PFNA）治疗不稳定股骨转子间骨折的临床疗效。方法2009年1月至2011年3月采用PFNA内固定治疗不稳定股骨转子间骨折患者96例，男56例，女40例；年龄59-95岁，平均77.6岁；左侧40例，右侧56例。致伤原因：平地跌倒72例，交通伤15例，高处坠落9例。骨折根据按Evans- Jensen分型：Ⅲ型61例，Ⅳ型35例。均为闭合性骨折，受伤至手术时间3-16 d，平均5.1d。结果本组96例患者术中出血100-300ml，平均120ml；手术时间40-80 min，平均51.0min。2例患者在术后2个月合并脑血管疾病死亡，剩余94例均获随访，随访时间12-32个月，平均15.2个月。骨折愈合时间10-14周，平均11.2周。术后肺部感染4例，下肢深静脉栓塞2例。髋关节功能恢复程度参照Harris评分：优55例，良31例，可6例，差2例，优良率91.5％。随访期间无手术部位感染、无髋内翻、内固定折断及骨折再移位，无螺旋刀片断裂、拔出和切出等并发症。结论PFNA具有手术时间短、创伤小、出血少、固定可靠和并发症少等优点，是一种有效治疗不稳定股骨转子间骨折的方法。Objective To evaluate the efficacy of proximal femoral nail antirotation （PFNA） in treatment of unstable femoral intertrochanteric fractures. Methods Ninety six patients with unstable femoral intertrochanteric fractures were treated with PFNA in our hospital from January 2009 to March 2011, including 56 males and 40 females with an average age of 77.6 y （59-95 y）. The duration from injury to operation was 3-16 d. According to Evans- Jensen classification, 61 cases were classified as typeⅢand 35 as typeⅣ. Results The average volume of intraoperative blood loss was 120 ml（100-300 ml） and the average operation time was 51.0 min（40-80 min）. Among 96 cases, 2 died and the remaining 94 cases were fol owed up for 12-32 months （average 15.2 months）.The average fracture healing time was 11.2 w （10-14 w）.According to the Harris functional scoring, the results were excel ent in 55 cases, good in 31, fair in 6 and poor in 2 with an excel ent and good rate of 91.5%. Four cases were compli-cated with pulmonary infection and 2 with lower limb venous thrombosis after surgery. No surgical site infection, hip varus defor-mity, implant failure and displacement of fracture were observed. Conclusion PFNA is effective in treatment of unstable femoral intertrochanteric fractures, with short operation time, minor surgical trauma, less blood loss, stable fixation and low complication rate.

关 键 词：股骨转子间骨折 骨折固定术 内 股骨近端髓内钉 

分 类 号：R687.3[医药卫生—骨科学]