不同长度亚洲型股骨近端防旋髓内钉治疗股骨转子间骨折的比较  

Comparison of different length Asian proximal femoral nail anti-rotation for treatment of femoral intertrochanteric fractures

作　　者：梁浩锋[1,2] 曾晖[3] 肖德明[3] 翁鉴[3] 辛风[3] 解笑宸[3] 

机构地区：[1]汕头大学医学院,08级临床七年制广东汕头515041 [2]北京大学深圳医院骨关节科,广东深圳518036 [3]单县东大医院骨外科,山东单县274300

出　　处：《临床骨科杂志》2015年第6期708-711,共4页Journal of Clinical Orthopaedics

摘　　要：目的比较不同长度亚洲型股骨近端防旋髓内钉(PFNA-Ⅱ)治疗A1及A2型股骨转子间骨折的临床效果。方法采用PFNA-Ⅱ治疗80例A1及A2型股骨转子间骨折患者,根据PFNA-Ⅱ主钉长度的不同分为短钉组(170 mm,35例)和长钉组(200、240 mm,45例),比较两组的手术时间、术中失血量、隐性失血量、输血率、钉尖至股骨前皮质的距离、钉尖抵触股骨前皮质的发生率、住院时间、Harris髋关节功能评分及术后并发症等指标。结果两组住院时间、Harris髋关节功能评分及术后并发症等比较差异均无统计学意义(P>0.05)。与长钉组比较,短钉组手术时间短,术中失血量、隐性失血量少,钉尖至股骨前皮质的距离长,输血率、钉尖抵触股骨前皮质的发生率低,差异均有统计学意义(P<0.05)。结论 PFNA-Ⅱ长、短钉治疗A1及A2型股骨转子间骨折均可获得良好的临床疗效;但短钉具有减少手术创伤、吻合股骨前弓形态的优势。因此建议临床在长、短钉均适用的情况下,可选择短钉。Objective To compare the clinical outcome of Asian proximal femoral nail anti-rotation（ PFNA-Ⅱ） with different length in the treatment of femoral intertrochanteric fractures（ type A1,A2）. Methods A study of 80 patients with femoral intertrochanteric fractures（ type A1,A2） were conducted,35 patients of which were operated with short PFNA-Ⅱ（ 170 mm）,while 45 patients with long ones（ 200,240 mm）. Comparisons were made between two groups in operative time,intraoperative bleeding,hidden blood loss,transfusion rate,distance from tip to anterior cortex,rate of nail tip anterior abutment,hospitalization time,Harris hip score and postoperative complications. Results There were no significant differences between two groups in hospitalization time,Harris hip score of and postoperative complications（ P〉0. 05）. Compared with long nails,short nails showed less operative time,fewer intraoperative bleeding and hidden blood loss,longer distance from tip to anterior cortex and lower transfusion rate and rate of anterior abutment,the differences were statistically significant（ P〈0. 05）. Conclusions Both long and short nails achieve well clinical outcome in the treatment of femoral intertrochanteric fractures（ type A1,A2）,however short nails demonstrate more therapeutic advantage due to less surgical trauma and better geometric match with femur,thus short nails are preferred in the cases that both long and short nails are acceptable.

关 键 词：股骨转子间骨折 股骨近端防旋髓内钉 长钉 短钉 

分 类 号：R683.42[医药卫生—骨科学] R687.33[医药卫生—外科学]