CAJ | 학술논문

目的探讨股骨近端防旋髓内钉(PFNA)治疗老年股骨转子间骨折的闭合复位技巧,并总结经验. 方法 2006年3月至2010年12月采用闭合复位PFNA治疗73例股骨转子间骨折患者,男26例,女47例；年龄63～97岁,平均80.6岁.骨折按AO分型:31A2型64例,31A3型9例；按改良Evans分型:ⅡA型15例,ⅡB型16例,Ⅲ型42例.术前仔细阅读患者影像资料,通过牵引、内旋、后侧支撑及撬拨等方法进行闭合复位,选择合适长度的PFNA进行内固定.应用Fogagnolo复位标准评定骨折复位质量,采用髋关节Harris评分评估患髋功能. 结果 55例(75.3％)患者术后获12 ～48个月(平均27 4个月)随访,18例患者失访(包括9例死亡患者).应用Fogagnolo复位标准评价骨折复位质量:优43例,可12例.骨折愈合时间为8～16周,平均10周.患者术后平均8周(6～16周)可完全负重行走.无感染、深静脉血栓形成、髋内翻畸形、股骨头切割及断钉发生,其中2例因术后摔倒致主钉远端股骨干骨折,二期行加长PFNA内固定治疗.按髋关节Harris评分标准评定患髋功能:优34例,良16例,中5例,优良率为90.9％.结论对于老年股骨转子间骨折,闭合复位时可以通过一定的复位技巧来纠正内翻移位、向后成角移位及旋转移位等情况,从而提高骨折复位质量,顺利地应用PFNA进行徽创治疗.
목적 탐토고골근단방선수내정(PFNA)치료노년고골전자간골절적폐합복위기교,병총결경험. 방법 2006년3월지2010년12월채용폐합복위PFNA치료73례고골전자간골절환자,남26례,녀47례；년령63～97세,평균80.6세.골절안AO분형:31A2형64례,31A3형9례；안개량Evans분형:ⅡA형15례,ⅡB형16례,Ⅲ형42례.술전자세열독환자영상자료,통과견인、내선、후측지탱급효발등방법진행폐합복위,선택합괄장도적PFNA진행내고정.응용Fogagnolo복위표준평정골절복위질량,채용관관절Harris평분평고환관공능. 결과 55례(75.3％)환자술후획12 ～48개월(평균27 4개월)수방,18례환자실방(포괄9례사망환자).응용Fogagnolo복위표준평개골절복위질량:우43례,가12례.골절유합시간위8～16주,평균10주.환자술후평균8주(6～16주)가완전부중행주.무감염、심정맥혈전형성、관내번기형、고골두절할급단정발생,기중2례인술후솔도치주정원단고골간골절,이기행가장PFNA내고정치료.안관관절Harris평분표준평정환관공능:우34례,량16례,중5례,우량솔위90.9％.결론 대우노년고골전자간골절,폐합복위시가이통과일정적복위기교래규정내번이위、향후성각이위급선전이위등정황,종이제고골절복위질량,순리지응용PFNA진행휘창치료.
Objective To discuss the reduction skills in the treatment of geratic femoral intertrochanteric fractures with proximal femoral nail anti-rotation (PFNA). Methods From March 2006 to December 2010,73 old patients with femoral intertrochanteric fractures were treated with PFNA.They were 26 males and 47 females,with an average age of 80.6 years (ranged from 63 to 97 years).According to the AO classification,there were 64 cases of type 31A2 and 9 cases of 31A3.According to the modified Evans classification,there were 15 cases of type ⅡA,16 cases of ⅡB and 42 cases of type Ⅲ.Close reduction was conducted through traction,internal rotation,posterior buttress and prying.Internal fixation was performed with appropriate PFNA.Adequacy of reduction was evaluated according to the criteria of Fogagnolo and hip function according to the Harris score. Results Eighteen patients were lost to the follow-up,including 9deaths.The other 55 patients (75.3％) were followed up for 27.4 months on average (ranging from 12 to 48months).Reduction was good in 43 cases and acceptable in 12 cases.The mean time of bone union was 10weeks (ranging from 8 to 16 weeks).The mean time for complete weight loading was 8 weeks (rangtng from 6 to 16 weeks).No wound infection,deep vein thrombosis,hip varus deformity,femoral head cutout,or nail breakage happened.Two distal femoral fractures occurred due to postoperative fall and were treated with secondary internal fixation with extended PFNA.The hip function was excellent in 34 cases,good in 16 cases and moderate in 5 cases,with a good to excellent rate of 90.9 ％. Conclusion In the treatment of geratic femoral intertrochanteric fractures with PFNA,unsatisfactory reduction can be rectified through skills like traction,internal rotation,posterior buttress and prying.