改良进钉点阶梯开口法在股骨转子间骨折股骨近端防旋髓内钉内固定术中的应用  

Application of modified proximal femoral nail antirotation infix position and serial opening for the treatment of femoral intertrochanter fracture

作　　者：肖奕增 黄东海 王清铿 Xiao Yizeng;Huang Donghai;Wang Qingkeng(Department of Orthopeadics of the PLA 910th Hospital,Quanzhou Fujian,362000,China)

机构地区：[1]中国人民解放军联勤保障部队第九一〇医院骨科,福建泉州362000

出　　处：《生物骨科材料与临床研究》2022年第1期44-48,共5页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的探讨改良进钉点阶梯开口法应用于股骨转子间骨折股骨近端防旋髓内钉(PFNA)内固定术的临床疗效。方法回顾性分析2019年6月至2020年10月收治的69例股骨转子间骨折患者资料,其中38例采用改良进钉点阶梯开口法PFNA内固定治疗(改良组),31例采用常规进钉点常规开口法PFNA内固定治疗(常规组),比较两组定位开口扩髓时间、定位开口扩髓过程中透视次数、大转子后侧骨折块髓内钉串住固定率、骨折愈合时间、术后1个月和3个月髋关节功能评分。结果所有患者随访6个月,改良组定位开口扩髓时间、定位开口扩髓过程中透视次数均少于常规组(P<0.05),改良组大转子后侧骨折块髓内钉串住固定率高于常规组(P<0.05)。两组骨折愈合时间比较,差异无统计学意义(P>0.05);髋关节功能评分:术后1个月改良组优于常规组(P<0.05)、术后3个月两组比较差异无统计学意义(P>0.05)。结论股骨转子间骨折PFNA内固定术中应用改良进钉点阶梯开口法可快速定位开口扩髓置钉,进钉点后移髓内钉可把大转子后侧骨折块串起来固定住增加骨折稳定性,改善PFNA固定效果,手术操作简单易学,缩短手术及麻醉时间,减少术中C型臂X射线透视次数。Objective To explore the clinical effect of PFNA with application of modified infix position and serial opening method for the treatment of femoral intertrochanter fracture.Methods Sixty-nine patients with femoral intertrochanter fracture from June 2019 to October 2020 were retrospectively analyzed.There were 38 patients treated by modified infix position and serial opening method(modified group)and 31 patients by conventional infix position and opening method(conventional group).Time for position and opening,X-ray frequency,fixation rate of posterior fracture segment of greater trochanter,time of fracture healing,hip function score at 1 and 3 months after surgery were compared.Results All patients were followed up for 6 months.Time for position and opening,X-ray frequency of modified group were less while the fixation rate was higher than that of the conventional group,and the difference had statistical significance(P<0.05).There was no statistical difference in fracture healing time between the two groups(P>0.05).Hip function score:1 month after surgery was better than conventional(P<0.05)and no statistical difference at 3 months after surgery(P>0.05).Conclusion The application of modified infix position and opening method of PFNA enhances the fracture stability and improves the PFNA fixation effect significantly,the skill is easily obtained and shortens the operation and anesthesia time,and reduces the number of X-ray during operation.

关 键 词：股骨转子间骨折 改良进钉点 阶梯开口法 股骨近端防旋髓内钉 

分 类 号：R683.42[医药卫生—骨科学]