中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2011年
11期
990-994
,共5页
李慧武%孙月华%史定伟%唐坚%俞超%龚伟华%朱振安%王友%戴尅戎
李慧武%孫月華%史定偉%唐堅%俞超%龔偉華%硃振安%王友%戴尅戎
리혜무%손월화%사정위%당견%유초%공위화%주진안%왕우%대극융
股骨骨折%骨折固定术,内%治疗结果
股骨骨摺%骨摺固定術,內%治療結果
고골골절%골절고정술,내%치료결과
Femoral fractures%Fracture fixation,internal%Treatment outcome
目的 探讨股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)治疗老年股骨转子间骨折的手术疗效.方法 自2007年4月至2009年7月应用PFNA治疗股骨转子间骨折112例,其中男34例,女78例;平均年龄76岁.AO分型:31 -A2型80例,31 -A3型32例.Singh指数分类:Ⅰ级4例,Ⅱ级21例,Ⅲ级70例,Ⅳ级15例;骨折前2例跛行.低能量损伤97例,高能量损伤15例.采用Salvati - Wilson评分对髋关节功能进行评估.结果 112例患者中90例接受12 ~24个月随访,平均18.6个月.Salvati - Wilson评分为(29.98±5.18)分:优41例,良40例,可6例,差3例,优良率为90%.术中主要问题为插钉困难22例,其中3例患者在插钉过程中导致股骨近端外侧皮质破裂.敲击螺旋刀片过程中造成骨折断端不同程度的移位或分离34例,远端锁钉困难9例.术后并发症中局部并发症包括髋部疼痛21例,股部疼痛4例,明显髋内翻2例,延迟愈合7例.无论Singh指数为何种类型均未见螺旋刀片切出或穿透股骨头,也未见股骨干骨折发生.全身并发症包括心脑血管疾病1例,肺部感染4例,深静脉栓塞1例,会阴部淤血或肿胀17例.结论 PFNA是治疗股骨转子间骨折特别是骨质疏松性骨折的有效方法,但骨折延迟愈合以及髓内钉与股骨近端形态的不匹配还有待进一步解决.
目的 探討股骨近耑防鏇髓內釘(proximal femoral nail antirotation,PFNA)治療老年股骨轉子間骨摺的手術療效.方法 自2007年4月至2009年7月應用PFNA治療股骨轉子間骨摺112例,其中男34例,女78例;平均年齡76歲.AO分型:31 -A2型80例,31 -A3型32例.Singh指數分類:Ⅰ級4例,Ⅱ級21例,Ⅲ級70例,Ⅳ級15例;骨摺前2例跛行.低能量損傷97例,高能量損傷15例.採用Salvati - Wilson評分對髖關節功能進行評估.結果 112例患者中90例接受12 ~24箇月隨訪,平均18.6箇月.Salvati - Wilson評分為(29.98±5.18)分:優41例,良40例,可6例,差3例,優良率為90%.術中主要問題為插釘睏難22例,其中3例患者在插釘過程中導緻股骨近耑外側皮質破裂.敲擊螺鏇刀片過程中造成骨摺斷耑不同程度的移位或分離34例,遠耑鎖釘睏難9例.術後併髮癥中跼部併髮癥包括髖部疼痛21例,股部疼痛4例,明顯髖內翻2例,延遲愈閤7例.無論Singh指數為何種類型均未見螺鏇刀片切齣或穿透股骨頭,也未見股骨榦骨摺髮生.全身併髮癥包括心腦血管疾病1例,肺部感染4例,深靜脈栓塞1例,會陰部淤血或腫脹17例.結論 PFNA是治療股骨轉子間骨摺特彆是骨質疏鬆性骨摺的有效方法,但骨摺延遲愈閤以及髓內釘與股骨近耑形態的不匹配還有待進一步解決.
목적 탐토고골근단방선수내정(proximal femoral nail antirotation,PFNA)치료노년고골전자간골절적수술료효.방법 자2007년4월지2009년7월응용PFNA치료고골전자간골절112례,기중남34례,녀78례;평균년령76세.AO분형:31 -A2형80례,31 -A3형32례.Singh지수분류:Ⅰ급4례,Ⅱ급21례,Ⅲ급70례,Ⅳ급15례;골절전2례파행.저능량손상97례,고능량손상15례.채용Salvati - Wilson평분대관관절공능진행평고.결과 112례환자중90례접수12 ~24개월수방,평균18.6개월.Salvati - Wilson평분위(29.98±5.18)분:우41례,량40례,가6례,차3례,우량솔위90%.술중주요문제위삽정곤난22례,기중3례환자재삽정과정중도치고골근단외측피질파렬.고격라선도편과정중조성골절단단불동정도적이위혹분리34례,원단쇄정곤난9례.술후병발증중국부병발증포괄관부동통21례,고부동통4례,명현관내번2례,연지유합7례.무론Singh지수위하충류형균미견라선도편절출혹천투고골두,야미견고골간골절발생.전신병발증포괄심뇌혈관질병1례,폐부감염4례,심정맥전새1례,회음부어혈혹종창17례.결론 PFNA시치료고골전자간골절특별시골질소송성골절적유효방법,단골절연지유합이급수내정여고골근단형태적불필배환유대진일보해결.
Objective To investigate the clinical value of proximal femoral nail antirotation ( PFNA) in treatment of intertrochanteric fractures.Methods From April 2007 to July 2009,112 patients with intertrochanteric fractures were treated by using PFNA.There were 34 males and 78 females,at mean age of 76 years.Of all,80 patients were with type 31-A2 fracture and 32 with type 31-A3 fractures according to AO classification.According to Singh index classification,there were 4 patients at grade Ⅰ,21 at grade Ⅱ,70 at grade Ⅲ and 15 at grade Ⅳ.The fracture was caused by low-energy injury in 97 patients and by high-energy injury in 15.The Salvati-Wilson score was used to evaluate the hip function postoperatively.Results Ninety patients received 12-24 months follow-up (average 18.6 months).The Salvati-Wilson score was (29.98 ± 5.18 ) points.The result was excellent in 41 patients,good in 40,fair in 6 and poor in 3,with excellenct rate of 90%.The introduction of the nail in operation was difficult in 22 patients,of which 3 patients suffered femoral cortex rupture.Displacement or separation of the fracture segments occurred in 34 patients and distal locking difficulty in nine during the screw blade tapping process.Local complications included hip pain in 21 patients,thigh pain in 4,apparent coxa vara in 2 and delayed healing in 7.There were no cutting-out or femoral shaft fractures no matter what type of Singh index was.The systemic complications included cardiovascular and cerebrovascular disease in one patient,pulmonary infection in four,deep vein embolism in one and perineum congestion or swelling in seventeen.Conclusion PFNA is effective in treating intertrochanteric fractures especially osteoporotic fractures,but delayed healing of the fractures and the mismatch between the intramedullary nail and the proximal femoral morphology remain to be addressed.