Gadegone Wasudeo M, Shivashankar Bhaskaran, Lokhande Vijayanad, Salphale Yogesh
Department of Orthopaedic and Traumatology, Associate Professor of Orthopaedics, GMC, 442402 Chandrapur, Maharashtra, India.
Iyer Orthopaedic Centre, 103, Railway Lines, 413001 Solapur, Maharashtra, India.
SICOT J. 2017;3:12. doi: 10.1051/sicotj/2016052. Epub 2017 Feb 13.
Biomechanically proximal femoral nail (PFN) is a better choice of implant, still it is associated with screw breakage, cut out of screw through femoral head, Z effect, reverse Z effect, and lateral migration of screws. The purpose of this study is to evaluate the results of augmented PFN in terms of prevention of postoperative complications and failure rates in unstable trochanteric fractures.
We carried out a prospective study of 82 cases with unstable trochanteric femoral fractures from April 2010 to December 2015. Forty-two females and 40 males in the age group between 58 and 81 years were included in this study. There were 45 cases of AO 31 A2 (2.2, 2.3) and 37 cases of AO 31 A3 (3.1, 3.2, 3.3). Fractures were fixed by PFN with augmentation by an additional screw from trochanter to inferior quadrant of femoral head or cerclage wire to strengthen the lateral trochanteric wall.
The bone healing is observed in all the cases in the mean period of 14.2 weeks. Nine patients developed complications, including lateral migration of neck screws (n = 5), Z effect (n = 1), infection (n = 2), and breakage of distal interlocking bolt in one case. Removal of screws was required in five cases. Patients were followed up for a mean of 8.4 months. At the end of follow-up the Salvati and Wilson hip function was 32 (out of 40) in 88% of patients.
The stabilization of lateral trochanteric wall with additional screw or cerclage wire increases the stability of construct.
从生物力学角度来看，股骨近端髓内钉（PFN）是一种较好的植入物选择，但它仍存在螺钉断裂、螺钉穿出股骨头、Z效应、反向Z效应以及螺钉向外移位等问题。本研究的目的是评估增强型PFN在预防不稳定型转子间骨折术后并发症及降低失败率方面的效果。
我们对2010年4月至2015年12月期间的82例不稳定型股骨转子间骨折患者进行了一项前瞻性研究。本研究纳入了年龄在58至81岁之间的42名女性和40名男性。其中AO 31 A2（2.2，2.3）型骨折45例，AO 31 A3（3.1，3.2，3.3）型骨折37例。骨折采用PFN固定，并通过从转子向股骨头下象限附加一枚螺钉或使用环扎钢丝进行增强，以加强转子外侧壁。
所有病例均在平均14.2周的时间内实现了骨愈合。9例患者出现了并发症，包括颈螺钉向外移位（n = 5）、Z效应（n = 1）、感染（n = 2），还有1例出现远端交锁螺栓断裂。5例患者需要取出螺钉。患者平均随访8.4个月。随访结束时，88%的患者Salvati和Wilson髋关节功能评分为32分（满分40分）。
通过附加螺钉或环扎钢丝稳定转子外侧壁可增加内固定结构的稳定性。
