摘要
背景：PFNA内固定失效可见于诸多文献报道，但尚缺乏关于并发症原因、手术技巧及应对策略的系统性报道。目的：研究股骨近端防旋髓内钉（proximalfemoral nail antirotation, PFNA）内固定治疗股骨转子间骨折的并发症原因、手术技巧及应对策略，旨在降低并发症发生率，提高手术技术水平。方法：回顾性分析2012年1月至2015年1月应用PFNA闭合复位治疗128例股骨转子间骨折患者的临床资料，其中13例发生并发症，男9例，女4例；年龄45-82岁，平均（62.0±5.4）岁；根据AO/OTA分型：A1型4例，A2.1型1例，A3型8例；稳定性骨折5例（38.5%）；不稳定性骨折8例（61.5%）；均为新鲜骨折，排除病理性骨折。结果：128例中13例发生并发症，包括1例在术中损伤股深动脉，2例股骨近端爆裂骨折，1例股骨前壁穿破，2例螺旋刀片向内穿透股骨头，2例螺旋刀片向外侧切出，2例骨折不愈合，3例髋内翻畸形。结论：PFNA内固定治疗股骨转子间骨折失效的原因分为内在因素和外在因素，对于一些特殊类型的骨折制定个性化手术治疗方案以及康复计划是预防内固定失效的关键。
Background：There have been many literatures about the failure of internal fixation with proximal femoral nail antirotation （PFNA）, but it is short of systemic summary of the reasons about complications, surgical skills and coping strat-egies. Objective：To explore the causes of complications in patients with femoral intertrochanteric fractures and operating technique after PFNA fixation. Methods：A retrospective analysis was conducted to summarize the treatment of femoral in-tertrochanteric fractures with PFNA in 128 cases from January 2012 to January 2015. Complications occurred in 13 cases during the operation. There were 9 males and 4 females with an average age of （62.0 ± 5.4） years （range, 45-82 years）. Ac-cording to the AO/OTA classification, there were 4 cases of type A1, 1 case of type A2.1, and 8 cases of type A3. The frac-ture was stable in 5 cases （38.5%） and unstable in 8 cases （61.5%）. All patients were acute fractures, and pathological frac-tures were excluded. Results： Femoral profound artery was damaged in one case. Burst fracture occurred in the proximal femoral shaft in 2 cases. Femoral lateral wall was broken in one case. Nails cut into femoral head in 2 cases and through lat-eral wall in another 2 cases. Nonunion occurred in 2 cases. Coxa vara occurred in 3 cases. Conclusions：There are internal factors and external factors of the failure of PFNA treatment in the patients with femoral intertrochanteric fractures. Person-alized surgical treatment and rehabilitation program is the key to prevent the failure of internal fixation.
出处
《中国骨与关节外科》
2016年第1期44-48,共5页
Chinese Journal of Bone and Joint Surgery
关键词
髋骨折
内固定器
假体失效
Hip Fractures
Internal Fixators
Prosthesis Failure
