Wei Jie, Qin De-an, Guo Xiu-sheng
Zhongguo Gu Shang. 2015 Jun;28(6):572-5.
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).
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 type I (5 cases) type II (16 cases), type III (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.
All incisions were healed at stage I, 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.
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.
探讨股骨近端防旋髓内钉（PFNA）治疗股骨粗隆间骨折的临床疗效、关键注意事项以及外侧大转子壁的完整性。
回顾性分析2010年6月至2012年12月采用PFNA治疗的210例股骨粗隆间骨折患者，其中男性76例，女性134例，年龄46～96岁，平均71岁。所有骨折均由外伤引起，按Evans分型为Ⅰ型（5例）、Ⅱ型（16例）、Ⅲ型（73例）、Ⅳ型（116例）。观察患者下床时间、术后并发症、螺旋刀片移位情况及骨折愈合情况，采用Baumgaertner标准评估骨折复位质量，采用Harris标准评估髋关节功能。
所有切口均Ⅰ期愈合，除未重建外侧大转子壁的患者外，其余患者均未发生并发症，1周后可扶拐下床，术后10天均出院。178例患者获3～17个月随访，平均10个月。1例因螺旋刀片切割导致骨折不愈合移位，2例螺旋刀片向近端移位穿出股骨头，其余患者术后12～16周骨折愈合。按Baumgaertner标准，优良130例，可45例，差3例；按Harris评分，优107例，良65例，可3例，差3例。
PFNA具有髓内固定的力学优势，固定稳定、手术时间短、创伤小。掌握固定原则，处理术中不利因素，可获得满意的临床效果。术中重建外侧大转子壁的完整性可确保固定稳定并早期下床。
