Wang Wenyue, Yang Tianfu, Fang Yue, Wang Guanglin, Pu Jinsong, Liu Lei
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P R China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Nov;23(11):1306-10.
To investigate the operative method and to evaluate the clinical outcome of proximal femoral nail antirotation (PFNA) in treating reverse oblique fractures of intertrochanteric region of the femur.
From January 2007 to February 2008, 30 cases of reverse oblique fractures of intertrochanteric region of the femur were treated by closed reduction and fixation with PFNA, including 14 males and 16 females and aging 40-88 years old with an average of 68.6 years old. All patients had closed fractures. According to AO classification, there were 6 cases of 31-A3.1 type, 7 cases of 31-A3.2 type and 17 cases of 31-A3.3 types. The time from injury to operation was 2-14 days (with an average of 5.3 days). All 31-A3.1 and 31-A3.2 type fractures and 9 cases of AO 31-A3.3 type fractures were fixed with the standard PFNA, and 8 cases of 31-A3.3 type fractures with the PFNA-long. The clinical and radiological examinations were done at 1, 2, 3, 6, 12, and 18 months after operation. The clinical outcomes were evaluated according to the Sanders scoring.
Iatrogenic fracture of femoral shaft occurred in 1 case; no additional procedures were applied as fracture kept favorable stability. Superficial infection occurred in 1 case at 5 days after operation, wound healed after dressing change and intravenous antibiotic therapy. Other wounds healed by first intention. All cases were followed up for 12-19 months (mean 14.1 months). All fractures healed uneventfully after 12-30 weeks (mean 16.2 weeks). Five patients complained of hip pain, 2 patients had lateral leg pain, and the pain was eliminated after symptomatic treatment. One case complicated by ipsilateral fracture of the tibial plateau had functional disturbance of knee, and one case complicated by ipsilateral fracture of the acetabulum and pelvis had functional disturbance of hip, and the function was improved after functional exercise. No complications such as cut-out or breakage of the implants occurred. According to Sanders criteria, the clinical results were excellent in 22 cases, good in 6 cases, and poor in 2 cases. The excellent and good rate was 93.3%.
PFNA is an effective treatment method for reverse oblique fractures of intertrochanteric region of the femur, with a high rate of bone union, minor soft tissue damage, early functional exercise and acceptable complication related to implant.
探讨股骨近端防旋髓内钉（PFNA）治疗股骨转子间区域反向斜形骨折的手术方法并评估其临床疗效。
2007年1月至2008年2月，采用PFNA闭合复位固定治疗30例股骨转子间区域反向斜形骨折患者，其中男性14例，女性16例，年龄40 - 88岁，平均68.6岁。所有患者均为闭合性骨折。按AO分型，31 - A3.1型6例，31 - A3.2型7例，31 - A3.3型17例。受伤至手术时间为2 - 14天（平均5.3天）。所有31 - A3.1和31 - A3.2型骨折以及9例AO 31 - A3.3型骨折采用标准PFNA固定，8例31 - A3.3型骨折采用加长型PFNA固定。术后1、2、3、6、12和18个月进行临床及影像学检查。根据Sanders评分评估临床疗效。
1例发生股骨干医源性骨折，因骨折稳定性良好未采取进一步处理。1例术后5天发生浅表感染，经换药及静脉应用抗生素治疗后伤口愈合。其他伤口均一期愈合。所有病例随访12 - 19个月（平均14.1个月）。所有骨折在12 - 30周（平均16.2周）后均顺利愈合。5例患者诉髋部疼痛，2例患者诉小腿外侧疼痛，经对症治疗后疼痛消失。1例合并同侧胫骨平台骨折者膝关节功能障碍，1例合并同侧髋臼及骨盆骨折者髋关节功能障碍，经功能锻炼后功能改善。未发生内固定物切割或断裂等并发症。按Sanders标准，临床结果优22例，良6例，差2例。优良率为93.3%。
PFNA是治疗股骨转子间区域反向斜形骨折的有效方法，骨愈合率高，软组织损伤小，可早期进行功能锻炼，且内固定相关并发症可接受。
