股骨近端防旋髓内钉治疗股骨转子周围骨折  

Proximal femoral nail anti-rotation fixation for treatment of the peritrochanteric fracture of femur

作　　者：于晨 王泽勇 耿大伟 陈中 覃健 YU Chen;WANG Ze-yong;GENG Da-wei;CHEN Zhong;QIN Jian(Dept of Orthopaedics,Sir Run Run Hospital,Nanjing Medical University,Nanjing,Jiangsu 210000,China)

机构地区：[1]南京医科大学附属逸夫医院骨科,江苏南京210000

出　　处：《临床骨科杂志》2023年第6期856-860,共5页Journal of Clinical Orthopaedics

基　　金：江苏省卫健委高层次卫生人才“六个一工程”拔尖人才科研项目(编号:LGY2019093);江苏省南京医科大学基金面上项目(编号:2017NJMU224)。

摘　　要：目的探讨股骨近端防旋髓内钉(PFNA)治疗股骨转子周围骨折的疗效。方法采用PFNA治疗21例股骨转子周围骨折患者。记录术中出血量、手术时间、骨折复位质量、骨折愈合情况、疼痛VAS评分、并发症发生情况。采用Merle D′Aubigne Postel评分系统及Harris评分评价髋关节功能。结果患者均获得随访,时间9~28(14.24±4.58)个月。术中出血量100~600(238.10±160.40)ml,手术时间80~260(145.33±52.65)min。骨折复位质量:解剖复位3例,功能复位18例。切口均一期愈合。骨折均愈合,时间3~6个月。术后未发生血管、神经损伤及切口感染等情况,无内固定松动断裂、复位丢失、骨折不愈合、髋内翻、再骨折等并发症发生。术后9个月疼痛VAS评分0~3(0.62±0.92)分。末次随访时,采用Merle D′Aubigne Postel评分系统评价的髋关节功能优良率为19/21;采用Harris评分评价的髋关节功能优良率为18/21。结论PFNA治疗股骨转子周围骨折具有微创、固定可靠、生物力学稳定性好、并发症少、髋关节功能恢复好等优点,利于患者早期康复锻炼,临床疗效满意。Objective To investigate the efficacy of proximal femoral nail anti-rotation(PFNA)in the treatment of the peritrochanteric fracture of femur.Methods PFNA fixation was used to treat 21 patients with peritrochanteric fractures of the femur.The intraoperative bleeding volume,surgical time,fracture reduction quality,fracture healing,pain VAS and incidence of complications were recorded.The Merle D'Aubigne Postel scoring system and Harris scoring were used to evaluate hip joint function.Results All patients were followed up for 9~28(14.24±4.58)months.The intraoperative bleeding volume was 100~600(238.10±160.40)ml,and the surgical time was 80~260(145.33±52.65)min.Quality of fracture reduction was anatomical reduction in 3 cases,functional reduction in 18 cases.All incisions healed in one-stage.All fractures healed within 3~6 months.There were no postoperative vascular or nerve injuries or incision infections,and no complications such as loosening or broken of the internal fixation,reduction loss,nonunion,coxa vara,or re-fractures occurred.Nine months after surgery,the pain VAS were 0~3(0.62±0.92)points.At the last follow-up,the excellent-good rate of hip joint function evaluated with the Merle D'Aubigne Postel scoring system was 19/21,while the excellent and good rate of hip joint function evaluated with Harris scoring was 18/21.Conclusions PFNA has the advantages of minimally invasive,reliable fixation,good biomechanical stability,fewer complications,and good hip joint function in the treatment of the peritrochanteric fractures of femur,which is conducive to early rehabilitation and exercise for patients,and the clinical efficacy is satisfactory.

关 键 词：股骨转子间骨折 股骨转子下骨折 股骨近端防旋髓内钉 内固定 

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