Hohendorff B, Meyer P, Menezes D, Meier L, Elke R
SRO Spital Langenthal, Schweiz.
Unfallchirurg. 2005 Nov;108(11):938, 940, 941-6 passim. doi: 10.1007/s00113-005-0962-8.
Intramedullary implants, such as the proximal femur nails (PFN), are inserted for the treatment of per-, inter- and subtrochanteric fractures. The initial experiences with these PFN, carried out by AO/ASIF in 1996, have been published.
This study makes a systematic examination of the complications and clinical treatment results from 133 patients treated at our clinic from December 1997-2001 with 139 PFN in per-, inter- and subtrochanteric femur fractures. The mean age at the time of surgery was 78.4 years. All fractures were classified according to the AO system. The most frequent injuries were 31 A2.3 fractures (61.2%). All intraoperative image-converter images and all radiographs from the total period of treatment were evaluated retrospectively in accordance with 28 criteria. The degree of osteoporosis was estimated using the Singh classification.
A total of 44 (31.7%) complications arose in 31 (23.3%) patients. On 11 occasions, hip screw cut-out was observed. Of these, two cases involved a Z-effect and one an inverted Z-effect. Two patients suffered a femoral neck fracture following removal of the hip screws. There were 38 (27.3%) reoperations required with 13 changes in procedure. In autumn 2002, clinical follow-up examinations were carried out on 65 (48.9%) patients who were assessed according to the Merle d'Aubigné score. A total of 51 (38.3%) patients had died at the time of follow-up. Normal ambulation was achieved by 33.8% of patients, while 64.6% were free of pain.
The PFN is an appropriate implant in cases of per-, inter- and subtrochanteric femur fractures. Anatomical resetting and correct implant positioning are the keys to successful osteosynthesis. The risk of implant failure is highest in the case of multi-fragmentary per- and intertrochanteric fractures in which medial strengthening has been degraded in patients aged over 80 years. The clinical results in elderly patients are unsatisfactory.
髓内植入物，如股骨近端髓内钉（PFN），用于治疗股骨转子周围、转子间和转子下骨折。AO/ASIF于1996年对这些PFN进行的初步经验已发表。
本研究对1997年12月至2001年在我院接受治疗的133例患者使用139枚PFN治疗股骨转子周围、转子间和转子下骨折的并发症及临床治疗结果进行了系统检查。手术时的平均年龄为78.4岁。所有骨折均根据AO系统分类。最常见的损伤是31 A2.3骨折（61.2%）。根据28项标准对所有术中影像增强器图像和整个治疗期间的所有X线片进行回顾性评估。使用Singh分类法评估骨质疏松程度。
31例（23.3%）患者共出现44例（31.7%）并发症。观察到11次髋螺钉穿出。其中，2例涉及Z效应，1例涉及倒Z效应。2例患者在取出髋螺钉后发生股骨颈骨折。需要进行38次（27.3%）再次手术，其中13次改变了手术方式。2002年秋季，对65例（48.9%）患者进行了临床随访检查，并根据Merle d'Aubigné评分进行评估。随访时共有51例（38.3%）患者死亡。33.8%的患者实现了正常行走，64.6%的患者无疼痛。
PFN是治疗股骨转子周围、转子间和转子下骨折的合适植入物。解剖复位和正确的植入物定位是成功进行骨合成的关键。在80岁以上患者中，多段性转子周围和转子间骨折且内侧支撑减弱的情况下，植入物失败的风险最高。老年患者的临床结果并不理想。
