Qu Wanming, Zhou Hongbin, Zhang Xiangwei, Xiang Qinghua, Shen Wenbin, Yu Xin, Chen Wenyao, Li Xinzhi
Department of Orthopedics, Yiling People's Hospital of Yichang City, Yichang Hubei, 443100, P. R. China.
Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang Hubei, 443001, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Jun 15;39(6):680-685. doi: 10.7507/1002-1892.202503125.
To investigate the feasibility and effectiveness of precise-guided temporary fixation assistive devices in assisting the main nail guide pin placement and precise temporary fixation in proximal femoral nail antirotation (PFNA) internal fixation of femoral intertrochanteric fractures.
A prospective randomized controlled study was conducted to analyze the clinical data of 60 patients with femoral intertrochanteric fractures over 65 years old who met the selection criteria between January 2020 and June 2022 and were treated with PFNA internal fixation. The patients were randomly divided into the trial group (auxiliary device guided main nail guide pin placement and temporary fixation) and the control group (conventional treatment), with 30 cases in each group. There was no significant difference in baseline data such as gender, age, cause of injury, time from injury to operation, fracture side, AO/Orthopaedic Trauma Association (AO/OTA) classification, and combined medical diseases between the two groups ( >0.05). The operation time, times of main nail guide pin placement, intraoperative fluoroscopy frequency, intraoperative blood loss, and perioperative blood transfusion were recorded and compared between the two groups. The quality of fracture reduction was evaluated by CHANG Shimin criteria. Harris score was used to evaluate the hip function at 1 year after operation.
In the trial group, 2 temporary fixation needles were successfully placed 2-5 times, including 2 times in 13 cases (43.3%), 3 times in 8 cases (26.7%), 4 times in 7 cases (23.3%), and 5 times in 2 cases (6.7%). The operation time, times of main nail guide pin placement, intraoperative fluoroscopy frequency, and intraoperative blood loss in the trial group were significantly less than those in the control group, and the reduction quality score was significantly better than that in the control group ( <0.05). There was no significant difference in perioperative blood transfusion between the two groups ( >0.05). All patients were followed up 12-19 months (mean, 15 months). There was no complication such as incision infection, deep vein thrombosis, or internal fixation loosening. At 1 year after operation, the Harris score of the affected hip joint in the trial group was significantly higher than that in the control group ( <0.05).
The technique of main nail guide pin placement and temporary fixation under the guidance of auxiliary devices in PFNA internal fixation can achieve faster insertion of the main nail guide pin, accurate temporary fixation to maintain reduction, and avoid the subsequent operation space, so as to improve the effectiveness.
探讨精准导向临时固定辅助装置在股骨转子间骨折股骨近端防旋髓内钉（PFNA）内固定术中辅助主钉导针置入及精准临时固定的可行性和有效性。
进行一项前瞻性随机对照研究，分析2020年1月至2022年6月间60例符合入选标准的65岁以上股骨转子间骨折患者接受PFNA内固定治疗的临床资料。将患者随机分为试验组（辅助装置引导主钉导针置入及临时固定）和对照组（传统治疗），每组30例。两组患者的性别、年龄、受伤原因、受伤至手术时间、骨折侧、AO/骨科创伤协会（AO/OTA）分型及合并内科疾病等基线资料比较，差异无统计学意义（>0.05）。记录并比较两组患者的手术时间、主钉导针置入次数、术中透视次数、术中出血量及围手术期输血量。采用常世民标准评估骨折复位质量。采用Harris评分评估术后1年髋关节功能。
试验组2枚临时固定针成功置入2～5次，其中2次13例（43.3%），3次8例（26.7%），4次7例（23.3%），5次2例（6.7%）。试验组的手术时间、主钉导针置入次数、术中透视次数及术中出血量均显著少于对照组，复位质量评分显著优于对照组（<0.05）。两组围手术期输血量比较，差异无统计学意义（>0.05）。所有患者均获随访12～19个月（平均15个月）。未出现切口感染、深静脉血栓形成或内固定松动等并发症。术后1年，试验组患侧髋关节Harris评分显著高于对照组（<0.05）。
PFNA内固定术中辅助装置引导主钉导针置入及临时固定技术可实现主钉导针更快置入、精准临时固定以维持复位，并避免后续手术空间，从而提高有效性。
