Simmermacher R K J, Ljungqvist J, Bail H, Hockertz T, Vochteloo A J H, Ochs U, Werken Chr v d
Department of Surgery, University Medical Center Utrecht, The Netherlands.
Injury. 2008 Aug;39(8):932-9. doi: 10.1016/j.injury.2008.02.005. Epub 2008 Jun 25.
The treatment of unstable trochanteric femoral fractures is still challenging. The ideal implant should be easy to handle, allow for immediate full weight-bearing postoperatively and should have sufficient purchase in the femoral head/neck-fragment to limit cut-outs due to varus-deviation and rotation. The proximal femoral nail antirotation (PFNA), designed by AO, is an intramedullary device with a helical blade rather than a screw for better purchase in the femoral head and was tested in a clinical study. Consecutive patients with unstable trochanteric fractures (AO-classification 31.A.2 and A.3 only) were included and followed for 1 year. Primary objectives were assessment of operative and postoperative complications, whereas secondary objectives included surgical details, general complications and final outcome measurements. In 11 European clinics, 315 patients were included and treated with a PFNA. Almost all fractures healed within 6 months. Fifty-six percent of the patients regained the pre-trauma mobility and 18% died within the follow-up period. Forty-six implant-related complications--leading to 28 unplanned re-operations--were recorded, with four acetabular penetrations (three of which were after a new fall on that hip) and seven ipsilateral femoral shaft fractures as the most serious ones. As the joint-penetrations did not resemble the cut-out seen with other implants it is concluded that the PFNA--due to its helical blade--possibly limits the effects of early rotation of the head/neck-fragment in unstable trochanteric fractures and therefore seems currently to be the optimal implant for the treatment of these fractures especially in osteoporotic bone.
不稳定型股骨转子间骨折的治疗仍然具有挑战性。理想的植入物应易于操作，允许术后立即完全负重，并且在股骨头/颈骨折块中应有足够的把持力，以限制因内翻畸形和旋转导致的穿出。由AO设计的股骨近端抗旋髓内钉（PFNA）是一种髓内装置，带有螺旋刀片而非螺钉，以便在股骨头中获得更好的把持力，并在一项临床研究中进行了测试。纳入连续的不稳定型转子间骨折患者（仅AO分型31.A.2和A.3）并随访1年。主要目标是评估手术和术后并发症，而次要目标包括手术细节、一般并发症和最终结局测量。在11家欧洲诊所，315例患者纳入并接受了PFNA治疗。几乎所有骨折在6个月内愈合。56%的患者恢复了创伤前的活动能力，18%的患者在随访期内死亡。记录了46例与植入物相关的并发症，导致28例计划外再次手术，其中4例髋臼穿透（3例是在该髋部再次跌倒后）和7例同侧股骨干骨折最为严重。由于关节穿透与其他植入物所见的穿出不同，因此得出结论，PFNA由于其螺旋刀片，可能限制了不稳定型转子间骨折中股骨头/颈骨折块早期旋转的影响，因此目前似乎是治疗这些骨折尤其是骨质疏松性骨骨折的最佳植入物。
