Dousa P, Bartonícek J, Jehlicka D, Skála-Rosenbaum J
Ortopedicko-traumatologická klinika 3. LF UK a FNKV, Praha.
Acta Chir Orthop Traumatol Cech. 2002;69(1):22-30.
Presentation of the existing experience in the use of Proximal Femoral Nail Synthes (PFN) in trochanteric fractures.
A prospective study evaluating a group of 41 patients, 12 men and 29 women, average age 68 years (range 21-93 years) operated on between September 1997 and March 2001 by means of PFN. The group comprised 11 unstable peritrochanteric fractures (31-A2), 26 high subtrochanteric fractures (31-A3), 3 low subtrochanteric fractures and 1 pathological fracture.
Monitored were first of all preoperative and post-operative complications and final results.
The average duration of surgery was in the whole group of 41 patients 61 minutes (30-100 minutes), in the group of high subtrochanteris fractures 58 minutes (30-80 minutes). Average X-ray exposure including the time necessary of the reduction of the fracture was 2.9 minutes (1-6 minutes). In the group there occurred 3 complications. In the first case distal fixation of the mail failed. However, the fractures healed with any other complications. The second case was a patient with unstable peritrochanteric fracture when a too short lag screw was inserted to the head during surgery. In spite of this the fracture healed in 3 months, however, the resulting varus deformity caused a 1.5 cm shortening of the limb. In the third case, a female patient with a low subtrochanteric fracture, fragments were left in distraction and a large fragment of medial cortex bearing also lesser trochanter remained significantly displaced. Even after 6 months the fractures did not healed and therefore we performed dynamization of the nail and cancellous bone grafting in the region of the defect of medial cortex. Final results were evaluated in patients with a minimum follow-up of 6 months, i.e. in 22 patients, 9 patients did not come, 8 patients died. Most patients healed in 3 months (in total 20 patients of 28 followed up) but we set the minimum follow-up period of 6 months when we checked 22 patients of 39. Within six months 8 patients died and another 9 patients did not appear for the follow up. There were 17 cases of a high subtrochanteric fracture, 3 cases of unstable peritrochanteric fracture, one case of per-subtrochanteric fracture and one case of a low subtrochanteric fracture. Within 6 months the fracture healed in 21 patients, i.e. in 95% of the followed-up patients, of this in 20 cases (91%) in anatomical position.
In literature we have found only one publication (Simmermacher et al.--Injury 30, 1999) dealing with PFN which presents very good experience with this implant. Our good results were significantly influenced by preceding experience in the use of Gamma nail. In comparison with it PFN represents an implant of the next generation. However, the basic prerequisite of a good result is a perfect mastering of the surgical technique.
PFN is a method of choice in trochanteric fractures, namely in high subtrochanteric fractures (31-A3).
介绍股骨近端髓内钉系统（PFN）在转子间骨折治疗中的现有经验。
一项前瞻性研究，评估了1997年9月至2001年3月期间通过PFN手术治疗的41例患者，其中男性12例，女性29例，平均年龄68岁（范围21 - 93岁）。该组包括11例不稳定型转子周围骨折（31 - A2）、26例高位转子下骨折（31 - A3）、3例低位转子下骨折和1例病理性骨折。
首先监测术前和术后并发症以及最终结果。
41例患者的平均手术时长为61分钟（30 - 100分钟），高位转子下骨折组为58分钟（30 - 80分钟）。包括骨折复位所需时间在内的平均X线暴露时间为2.9分钟（1 - 6分钟）。该组发生了3例并发症。第一例是髓内钉远端固定失败，但骨折愈合且无其他并发症。第二例是一名不稳定型转子周围骨折患者，手术时向股骨头内插入的拉力螺钉过短。尽管如此，骨折在3个月内愈合，但由此导致的内翻畸形使肢体缩短了1.5厘米。第三例是一名低位转子下骨折的女性患者，骨折块处于分离状态，带有小转子的内侧皮质大骨折块仍明显移位。即使6个月后骨折仍未愈合，因此我们对髓内钉进行了动力化处理，并在内侧皮质缺损区域进行了松质骨植骨。对至少随访6个月的患者进行了最终结果评估，即22例患者，9例未前来，8例死亡。大多数患者在3个月内愈合（28例随访患者中共有20例），但我们将最低随访期设定为6个月，此时对39例患者中的22例进行了检查。6个月内8例患者死亡，另外9例患者未前来随访。有17例高位转子下骨折、3例不稳定型转子周围骨折、1例转子下骨折和1例低位转子下骨折。6个月内21例患者骨折愈合，即95%的随访患者骨折愈合，其中20例（91%）达到解剖复位。
在文献中我们仅发现一篇关于PFN的出版物（Simmermacher等人——《损伤》第30卷，1999年），该文献展示了使用这种植入物的良好经验。我们的良好结果受到先前使用Gamma钉经验的显著影响。与之相比，PFN代表了下一代植入物。然而，取得良好结果的基本前提是完美掌握手术技术。
PFN是转子间骨折，尤其是高位转子下骨折（31 - A3）的首选治疗方法。
