CAJ | 학술논문

目的探讨螺旋刀片型股骨近端髓内钉(proximal femoral nail antirotation,PFNA)治疗股骨转子间骨折的特点、适应证、手术技巧及初期疗效. 方法 2006年3月-2007年6月,采用PFNA治疗38例股骨转子间骨折患者,男17例,女21例;年龄35-93岁,平均65.4岁.按AO分类标准:31-A1型10例,31-A2型21例,31-A3型7例.所有患者均经骨科下肢牵引床牵引闭合复位,小切口置入PFNA. 结果本组38例患者平均手术时间50 min(35～105 min),平均出血量100 ml(30～300 ml),1例术中发生主钉远端股骨干外侧皮质劈裂.随访4～19个月,平均13个月,1例因并发症长时间卧床,32例息肢基本恢复到伤前功能,5例患肢功能较伤前减退.1例术后6个月发生脑梗死,经治疗后搀扶下可以在室内活动.所有患者均获得1期愈合,平均愈合时间9.5周.2例术后围术期发生呼吸系统疾病等并发症,其余患者均无切口感染、肺部感染、深静脉血栓、螺旋刀片切出股骨头、髋内翻等并发症.根据Harris髋关节功能评分:优20例,良13例,一般4例,差1例,优良率87%. 结论 PFNA治疗股骨转子间骨折具有创伤小、下床早、并发症少、内固定可靠、骨折愈合率高等优点,适用于各种类型转子间骨折,尤其适合老年骨质疏松患者,值得临床推广.
목적 탐토라선도편형고골근단수내정(proximal femoral nail antirotation,PFNA)치료고골전자간골절적특점、괄응증、수술기교급초기료효. 방법 2006년3월-2007년6월,채용PFNA치료38례고골전자간골절환자,남17례,녀21례;년령35-93세,평균65.4세.안AO분류표준:31-A1형10례,31-A2형21례,31-A3형7례.소유환자균경골과하지견인상견인폐합복위,소절구치입PFNA. 결과 본조38례환자평균수술시간50 min(35～105 min),평균출혈량100 ml(30～300 ml),1례술중발생주정원단고골간외측피질벽렬.수방4～19개월,평균13개월,1례인병발증장시간와상,32례식지기본회복도상전공능,5례환지공능교상전감퇴.1례술후6개월발생뇌경사,경치료후참부하가이재실내활동.소유환자균획득1기유합,평균유합시간9.5주.2례술후위술기발생호흡계통질병등병발증,기여환자균무절구감염、폐부감염、심정맥혈전、라선도편절출고골두、관내번등병발증.근거Harris관관절공능평분:우20례,량13례,일반4례,차1례,우량솔87%. 결론 PFNA치료고골전자간골절구유창상소、하상조、병발증소、내고정가고、골절유합솔고등우점,괄용우각충류형전자간골절,우기괄합노년골질소송환자,치득림상추엄.
Objective To investigate the advantages, indications, operative techniques and pre-liminary curative effect of proximal femoral nail antirotation(PFNA) in surgical treatment of intertrochan-teric fractures. Methods From March 2006 to June 2007, PFNA fixation was done on 38 patients with intertrochanteric fractures including 17 males and 21 females, at an average age of 65. 4 years(35-93 years). According to AO/ASIF classification, there were 10 patients with type 31-A1 fractures, 21 with type 31-A2 and 7 with type 31-A3. All patients were reduced through longitudinal traction on the traction table, with implantation of PFNA via a mini-incision. Results The mean operation duration was 50 minutes(35-105 minutes)and mean blood loss 100 ml(50-300 ml). All patients were successful except for 1 patient with split lateral cortical bone of distal shaft of the femur during operation. All pa-fients were followed up for average 13 months(4-19 months), which showed long-team bed stay due to severe complieations in 1 patient. Function recovery in 32 and deterioration of the injured limbs in 5. Cer-ebral infarction was found 6 months after operation in 1 patient, who was able to walk under support. Pri-mary bone union was achieved in all patients, with average healing time of 9. 5 weeks. There were no complications such as infection of incisional wound, pulmonary infection, phlebothrombosis, over incision or coxa adducta, except that 2 patients had perioperative respiratory system disease. According to Harris hip rating scale system. The result was excellent in 20 patients, good in 13, common in 4 and poor in 1, with total excellence rate of 89%. Conclusions As a new technique, PFNA has advantages of litth trauma. Early get-out-of-bed exercise, few complications, rigid fixation and high bone union rate and is suitable for all kinds of intertrochanteric fractures especially for old patients with osteoporosis.