[1]邱俊钦 林任 林焱斌△ 林伟.小切口防旋股骨近端髓内钉治疗A3型股骨转子间骨折[J].中国中医骨伤科杂志,2016,24(05):68-70.
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小切口防旋股骨近端髓内钉治疗A3型股骨转子间骨折
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第24卷
期数:
2016年05期
页码:
68-70
栏目:
临床报道
出版日期:
2016-05-15

文章信息/Info

文章编号:
1005-0205(2016)05-0068-03
作者:
邱俊钦1 林任1 林焱斌1△ 林伟1
1.厦门大学附属福州第二医院(福州,350007)
△.通信作者 E-mail:shengqiu0313047@liyu.com
关键词:
防旋股骨近端髓内钉;  A3型;  股骨转子间骨折
分类号:
R683.42
文献标志码:
B
摘要:
目的:评价采用小切口防旋股骨近端髓内钉(Proximal Femoral Nail Anti-rotation,PFNA)治疗A3型股骨转子间骨折的临床疗效。方法:2009年6月至2012年12月136例A3型股骨转子间骨折,按AO分型:A3.1型36例; A3.2型24例; A3.3型76例。分别采用闭合复位、小切口辅助复位+防旋股骨近端髓内钉治疗。分别统计手术时间、术中输血量、透视次数、并发症及术后疗效。结果:1)手术时间、术后并发症:组间比较差异无统计学意义(P>0.05); 2)术中出血量、术中透视次数:组间比较均有显著差异(P<0.05),术中出血量小切口组>闭合复位组,术中透视次数小切口组<闭合复位组; 差异有统计学意义(P<0.01); 3)疗效比较:闭合复位组及小切口组优良率分别为90.4%和93.7%,组间差异无统计学意义(P>0.05)。结论:两种复位方法结合PFNA治疗A3股骨转子间骨折,均可取得良好疗效。小切口感触辅助复位,有利于术中纠正髋内翻、近端旋转,大大减少术中透视,同时还可用作骨折端植骨的通道,植入自体股骨转子部开口扩髓时产生的大量优质松质,一举两得。通过经验和随访病例证实了小切口辅助复位治疗A3型股骨转子间骨折的优势性,值得临床应用。

参考文献/References:

[1] Kammerlander C,Gebhard F,Meier C,et al.Standardised cement augmentation of the PFNA using a perforated blade:a new technique and preliminary clinical results,a prospective multicentre trial[J].Injury,2011,42(12):1484-1490.
[2] Hornby R,Evans JG,Vardon V.Operative or conservative treatment for trochanteric fractures of the femur:a randomised epidemiological trial in elderly patients[J].J Bone Joint Surg Br,1989,71(4):619-623.
[3] Lorich DG,Geller DS,Nielson JH.Osteoporotic pertrochanteric hip fractures:management and current controversies[J].Instr Course Lect,2004,53:441-454.
[4] Pelet S,Arlettaz Y,Chevalley F.Osteosynthesis of per-and subtrochanteric fractures by blade plate versus gamma nail:a randomized prospective study[J].Surg,2001,7(3):126-133.
[5] Sadowski C,Lübbeke A,Saudan M,et al.Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate:a prospective,randomized study[J].J Bone Joint Surg Am,2002,84-A(3):372-381.
[6] 庞军,王飞,苏晨晨,等.股骨粗隆间骨折DHS与PFNA内固定的微创治疗方法[J].中国骨与关节损伤杂志,2014,29(6):591-592.
[7] Pu JS,Liu L,Wang GL,et al.Results of the proximal femoral nail anti-rotation(PFNA)in elderly Chinese patients[J].Int Orthop,2009,33(5):1441-1444.
[8] 陈柯,刘立云,刘又文,等.防旋股骨近端髓内钉微创治疗老年股骨转子间骨折临床研究[J].中国中医骨伤科杂志,2011,19(3):23-24.
[9] Gardenbroek TJ,Segers MJ,Simmermacher RK,et al.The proximal femur nail antirotation:an identifiable improvement in the treatment of unstable pertrochanteric fractures[J].J Trauma,2011,71(1):169-174.
[10] Xu YZ,Geng DC,Mao HQ,et al.A comparison of the proximal femoral nail antirotation device and dynamic hip screw in the treatment of unstable pertrochanteric fracture[J].J Int Med Res,2010,38(4):1266-1275.
[11] Garg B,Marimuthu K,Kumar U,et al.Outcome of short proximal femoral nail antirotation and dynamic hip screw for fixation of unstable trochan teric fractures.A randomised prospective comparative tria[J].Hip Iat,2011,580(1):41-49.
[12] Knobe M,Drescher W,Heussen N,et al.Is helical blade nailing superior to locked minimally invasive plating in unstable pertrochanteric fractures[J].Clin Orthop Relat Res,2012,470(8):2302-2312.
[13] 林焱斌,李仁斌,张怡元,等.交锁髓内钉小切口感触辅助复位结合自体髓内取骨植骨治疗股骨干骨折[J].中华创伤骨科杂志,2012,14(3):262-264.
[14] Baumgaertner MR,Solberg BD.Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip[J].J Bone Joint Surg Br,1997,79(6):969-971.
[15] Lenich A,Fierlbeck J,Al-Munajjed A,et al.First clinical and biomechanical results of the trochanteric fixation nail(TFN)[J].Technol Health Care,2006,14(4-5):403-409.
[16] Güven M,Yavuz U,Kadiolu B,et al.Importance of screw position in intertrochanteric femoral fractures treated by dynamic hip screw[J].Orthopaedics & Traumatology:Surgery & Research,2010,96(1):33-34.
[17] Zhou JQ,Chang SM.Failure of PFNA:Helical blade perforation and tip-apex distance[J].Injury,2012(7):1227-1228.

更新日期/Last Update: 2016-05-15