CAJ | 학술논문

目的：探讨闭合复位加长型股骨近端防旋髓内钉（ proximal femoral nail antirotation ，PFNA）内固定治疗股骨干骨折合并同侧股骨粗隆间骨折的临床疗效。方法2010年1月～2013年1月采用闭合复位加长型PFNA内固定治疗股骨干骨折合并同侧股骨粗隆间骨折12例。股骨粗隆间骨折按Evans分型，Ⅰ型10例，Ⅱ型2例。股骨干骨折按AO分型，A1型2例，B1型1例，B2型2例，B3型4例，C1型2例，C3型1例。术中利用牵引架闭合复位股骨干骨折，通过提拉钉纠正旋转及分离移位，再复位股骨粗隆间骨折，在C形臂X线机透视引导下，于大粗隆顶点打入导针，根据股骨髓腔大小插入合适直径的PFNA主钉，近端打入螺旋刀片，远端静态锁定。结果手术时间62～155 min，平均86．4 min。术中出血量80～240 ml，平均92．3 ml。11例随访6～24个月，平均12个月：均获得骨折愈合，股骨粗隆间骨折愈合时间8～12周，平均10周，股骨干骨折愈合时间16～36周，平均24周；无螺旋刀片切割、退出，髋内翻畸形及下肢短缩等并发症；按髋关节功能评分：优9例，良1例，可1例，优良率90．9％（10／11）。结论闭合复位加长型PFNA内固定治疗股骨干骨折合并同侧股骨粗隆间骨折，操作简单，固定可靠，是股骨干骨折合并同侧股骨粗隆间骨折的理想内固定物。
목적：탐토폐합복위가장형고골근단방선수내정（ proximal femoral nail antirotation ，PFNA）내고정치료고골간골절합병동측고골조륭간골절적림상료효。방법2010년1월～2013년1월채용폐합복위가장형PFNA내고정치료고골간골절합병동측고골조륭간골절12례。고골조륭간골절안Evans분형，Ⅰ형10례，Ⅱ형2례。고골간골절안AO분형，A1형2례，B1형1례，B2형2례，B3형4례，C1형2례，C3형1례。술중이용견인가폐합복위고골간골절，통과제랍정규정선전급분리이위，재복위고골조륭간골절，재C형비X선궤투시인도하，우대조륭정점타입도침，근거고골수강대소삽입합괄직경적PFNA주정，근단타입라선도편，원단정태쇄정。결과수술시간62～155 min，평균86．4 min。술중출혈량80～240 ml，평균92．3 ml。11례수방6～24개월，평균12개월：균획득골절유합，고골조륭간골절유합시간8～12주，평균10주，고골간골절유합시간16～36주，평균24주；무라선도편절할、퇴출，관내번기형급하지단축등병발증；안관관절공능평분：우9례，량1례，가1례，우량솔90．9％（10／11）。결론폐합복위가장형PFNA내고정치료고골간골절합병동측고골조륭간골절，조작간단，고정가고，시고골간골절합병동측고골조륭간골절적이상내고정물。
Objective To investigate clinical effects of closed reduction and internal fixation using long proximal femoral nail antirotation ( PFNA) in the treatment of femoral shaft fracture and ipsilateral peritrochanteric fracture . Methods From January 2010 to January 2013, 12 patients with femoral shaft fracture and ipsilateral peritrochanteric fracture were treated with closed reduction and internal fixation using long proximal femoral nail antirotation .According to the Evans classification of ipsilateral peritrochanteric fracture, there were 10 cases of type Ⅰand 2 cases of typeⅡ.According to the AO classification of femoral shaft fracture , there were 2 cases of type A1, 1 case of type B1, 2 cases of type B2, 4 cases of type B3, 2 cases of type C1, and 1 case of type C3.By application of intraoperative use of traction frame , a close reduction was carried out .Firstly the femoral shaft fracture was reduced , with correction by pulling the shift rotation and separation of the nail .Then the ipsilateral peritrochanteric fracture was treated under the C-arm X-ray fluoroscopy guidance .A guide pin was introduced at the apex of the greater trochanter , and according to the diameter of the femoral canal size , a suitable PFNA nail was inserted .A spiral blade was put into the proximal end , and the remote end was statically fixed. Results The mean operating time was 86.4 min (range, 62-155 min).The mean intraoperative blood loss was 92.3 ml (range, 80-240 ml).Eleven patients were followed up for an average of 12 months (range, 6-24 months).Bone union was achieved in all the cases .The mean period for healing of femoral shaft fracture and ipsilateral peritrochanteric fracture was 24 weeks (range, 16-36 weeks) and 10 weeks (range, 8 -12 weeks), respectively.There were no infection, lag screw cut-out, femoral head necrosis , varus deformity or other comlications .According to the Harris scores , 9 patients were graded as excellent , 1 good, and 1 fair.The excellent and good rate was 90.9%(10/11). Conclusions It is a reliable and ideal method to treat femoral <br> shaft fracture and ipsilateral peritrochanteric fracture with closed reduction and internal fixation using long proximal femoral nail antirotation.The procedure has advantages of minimal invasion, firm fixation, less blood loss, short operation time, and high healing rate.