摘要
目的回顾性分析防旋股骨近端髓内钉(proximal femoral nail anti-rotation,PFNAR)在治疗粗隆间骨折中的应用和早期临床效果,总结手术技术,分析相关疗效影响因素。方法2006年7月-2007年5月,采用PFNAR治疗股骨粗隆间骨折19例,男8例,女11例;年龄45～87岁。致伤原因均为摔伤。左侧10例,右侧9例。按AO分型:A2型14例,A3型5例。记录手术时间、术中出血量、下地时间,观察骨折愈合情况,对随访时间超过9个月的患者采用Harris评分评估髋关节功能情况。结果19例手术时间为23～78min,平均47min;术中出血量50～120mL,平均85mL;下地时间2～14d,平均7.4d;完全负重时间10～14周,平均12.4周。术中无再骨折发生,无局部及深部感染。1例术后2d猝死,考虑为脂肪栓塞。17例获平均9.4个月随访。术后15～18周(平均16.5周)达骨性愈合,无骨折延迟愈合、髋内外翻畸形、螺钉切割或退钉等并发症发生。15例随访时间9个月以上,进行了Harris评分,优13例,良1例,中1例,优良率93.3%。结论PFNAR治疗不稳定性股骨粗隆间骨折,尤其是粉碎骨折、骨质疏松者,具有创伤小、操作简便、出血少、固定牢固及骨量丢失少等优点。
Objective To evaluate the primary clinical effect of proximal femoral nail anti-rotation （PFNAR） in treating femoral intertrochanteric fractures, to summarize operation skills and to analyze correlated curative effective influential factors. Methods From July 2006 to May 2007, 19 cases of intertrochanteric fractures （including 8 males, 11 females, aged 45-87 years old） were treated with closed reduction and PFNAR fixation. Fractures were caused by falling. The locations were left sides in 10 cases and right sides in 9 cases. According to AO classification, there were 14 cases of type A2 and 5 cases of type A3. Operative time, volume of blood loss and weight bear time were analyzed, the condition of fracture union was observed and the hip function was evaluated using Harris criterion after 9 months of follow-up. Results Operative time ranged 23-78 minutes with an average time of 47 minutes, the volume of blood loss ranged 50-120 mL with an average volume of 85 mL, getting-out-of-bed time ranged 2-14 days with an average time of 7.4 days; the weight bearing time ranged 10-14 weeks with an average time of 12.4 weeks. No intra-operative femoral fractures and no regional or deep infection occurred during hospitalization period. Seventeen cases were followed up from 3 months to 12 months with an average time of 9.4 months, and achieved bone healing within 15-18 weeks with an average time of 16.5 weeks. No complications such as delay healing, coxa vara or coxa valga, cut-out and screw extraction occurred. Fifteen cases were followed up over 9 months; according to the Harris criterion for evaluation, the results were excellent in 13 cases, good in 1 case and fair in 1 case, the excellent and good rate was 93.3%. Conclusion PFNAR has the advantages of micro invasion, easy-to-perform, less blood loss, less bone loss and stable fixation in treatment of unstable comminuted intertrochanteric fracture, especiallv in old patients with osteoporosis.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2008年第7期769-772,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
股骨粗隆间骨折
防旋股骨近端髓内钉
骨折内固定术
Femoral intertrochanteric fracture Proximal femoral nail anti-rotation Internal fixation of fracture
