| 防旋型股骨近端髓内钉治疗股骨粗隆间骨折及大粗隆外侧壁不完整型的疗效分析 |
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Received:November 04, 2014
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| 作者 | Author | 单位 | Unit | E-Mail |
| 魏杰 |
WEI Jie |
山西省人民医院, 山西 太原 030012 |
Department of Orthopaedics, Shanxi Provincial People's Hospital, Taiyuan 030012, Shanxi, China |
wjyx686868@126.Vom |
| 秦德安 |
QIN De-an |
山西省人民医院, 山西 太原 030012 |
Department of Orthopaedics, Shanxi Provincial People's Hospital, Taiyuan 030012, Shanxi, China |
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| 郭秀生 |
GUO Xiu-sheng |
山西省人民医院, 山西 太原 030012 |
Department of Orthopaedics, Shanxi Provincial People's Hospital, Taiyuan 030012, Shanxi, China |
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| 陈斌 |
CHEN Bin |
山西省人民医院, 山西 太原 030012 |
Department of Orthopaedics, Shanxi Provincial People's Hospital, Taiyuan 030012, Shanxi, China |
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| 期刊信息：《中国骨伤》2015年28卷，第6期，第572-575页 |
| DOI：10.3969/j.issn.1003-0034.2015.06.021 |
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目的:探讨防旋型股骨近端髓内钉( proximal femoral nail antirotation,PFNA)治疗股骨粗隆间骨折及大粗隆外侧壁不完整型的疗效和术中关键技术。
方法:回顾性分析2010年6月至2012年12月采用PFNA 治疗的股骨粗隆间骨折患者210例, 男76例, 女134例;年龄46～96岁, 平均71岁。均为外伤所致, 骨折按Evans分型, Ⅰ型5例, Ⅱ型16例, Ⅲ型73例, Ⅳ型116例。观察术后患者下床时间、全身并发症、螺旋刀片移位及骨折愈合情况, 并采用Baumgaertner标准评价骨折端复位质量, Harris髋部评分方法评价患者髋关节功能。
结果:术后切口均Ⅰ期愈合, 合并症控制良好, 无严重并发症发生, 除大粗隆外侧壁不完整型未重建者外, 其余患者均可在术后1周左右扶拐下床, 所有患者约在术后10 d顺利出院。178例术后获得随访, 时间3～17个月, 平均10个月。1例出现螺旋刀片切割, 骨折移位未愈合, 2例出现螺旋刀片向近端移动穿出股骨头, 其余患者在术后12～16周获得骨性愈合。术后根据Baumgaertner复位标准, 良好130例, 可以接受45例, 差3例;Harris髋部评分, 优107例, 良65例, 可3例, 差3例。
结论:PFNA具有髓内固定的力学优势, 固定牢靠, 手术时间短, 手术创伤小。只要规范掌握固定原则, 术中正确处理不利因素即可获得满意临床效果。对大粗隆外侧壁不完整型术中应重建以确保固定牢靠和早期下床。 |
| [关键词]:股骨骨折 骨折固定术, 髓内 外科手术 |
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| Curative effect analysis on proximal frmoral nail antirotation for the treatment of femoral intertrochanteric fracture and integrity of lateral trochanteric wall |
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Abstract:
Objective:To explore clinical efficacy and key matters for the treatment of femoral intertrochanteric fracture and integrity of lateral trochanteric wall by proximal frmoral nail antirotation (PFNA).
Methods:From June 2010 to December 2012, 210 femoral intertrochanteric fracture patients treated with PFNA were retrospectively analyzed, including 76 males and 134 females aged from 46 to 96 years old with an average of 71 years old. All fracture were caused by injury and classified to typeⅠ(5 cases), typeⅡ(16 cases), typeⅢ(73 cases) and type Ⅳ(116 cases) according to Evans classification. The time of getting out of bed, postoperative complications and displacement of screw blade and fracture healing were observed, Baumgaertner criteria were used to evaluate quality of fracture reduction, Harris criteria were used to evaulate hip joint function.
Results:All incisions were healed at stageⅠ, no complications occurred except incomplete of lateral trochanteric wall patients without reconstruction, other patients could get out of bed with crutches at one week and all patients discharged from hospital at 10 days after operation. One hundred and seventy-eight patients were followed up from 3 to 17 months with an average of 10 months. One case occurred unhealed fracture displacement caused by screw blade cutting, 2 cases occurred screw blade transfomed to proximal and out femoral head, other patients obtained fracture healing at 12 to 16 weeks after operation. According to Baumgaertner criteria, 130 cases obtained good results, 45 cases acceptable, and 3 poor; while 107 cases obtained excellent results, 65 good, 3 good and 3 poor according to Harris score.
Conclusion:PFNA with mechanical advantage of intramedullary fixation has advantsges of stable fixation, shorter operation time, minimally invasive. Satisfied clinical effects could obtained by grasping fixation principle, dealing with negative factors in operation. Intraoperative reconstruction for integrity of lateral trochanteric wall could assure stable fixation and earlier get out of bed. |
| KEYWORDS:Femoral fractures Fracture fixation,intramedullary Surgical procedure,operative |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 魏杰,秦德安,郭秀生,陈斌.防旋型股骨近端髓内钉治疗股骨粗隆间骨折及大粗隆外侧壁不完整型的疗效分析[J].中国骨伤,2015,28(6):572~575 |
| 英文格式: | WEI Jie,QIN De-an,GUO Xiu-sheng,CHEN Bin.Curative effect analysis on proximal frmoral nail antirotation for the treatment of femoral intertrochanteric fracture and integrity of lateral trochanteric wall[J].zhongguo gu shang / China J Orthop Trauma ,2015,28(6):572~575 |
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