亚洲型股骨顺行髓内钉治疗股骨骨折的临床疗效

摘要

Objective To investigate clinical outcomes of Asian antegrade femoral intramedullary nailing ( A2FN ) in the treatment of femoral fractures. Methods From March 2010 to December 2013, 38 patients with femoral fractures were treated surgically using A2FN in our department. There were 28 males and 10 females. The mean age was 48.8 years ( range: 19 - 70 years ). Causes of injury: 30 cases by traffic accidents, 8 cases by fall injuries. Fracture sites: 15 cases were of middle femoral shaft fractures, 11 cases of subtrochanteric femoral fractures, 8 cases of femoral shaft fractures combining with femoral neck fractures, 4 cases of femoral fragmental fractures. Twenty-two cases underwent close reduction. Sixteen cases underwent limited open reduction. Results The average surgical time was 70 minutes ( range: 50 - 120 min ). The average blood loss during the surgery was 220 ml ( range: 120 -600 ml ). All patients were followed up for an average of 15.1 months ( range: 10 - 22 months ). Fractures healed in all cases. The average healing time was 20.2 weeks ( range: 16 - 32 weeks ). All patients returned to independent living after the operation. No complications such as internal fixation loosening, infection or pulmonary embolism were found. According to HSS standardization, the excellent and good rate was 92.1% ( excellent in 25 cases, good in 10 cases, fair in 3 cases ). The mean Harris score was 91 points postoperatively ( range: 80 - 96 points ). Conclusions A2FN has satisfactory results in the treatment of femoral fractures. It is a less invasive and simple method with fewer complications, which maintains the stability effectively and promotes earlier functional rehabilitation.%目的 通过回顾性研究探讨亚洲型股骨顺行髓内钉 ( Asian antegrade femoral intramedullary nailing,A2FN ) 治疗股骨骨折的临床疗效.方法 2010 年 3 月至 2013 年 12 月我院采用 A2FN 治疗股骨骨折38 例.其中,男 28 例,女 10 例;年龄 19~70 岁,平均 48.8 岁.致伤原因:车祸伤 30 例,坠落伤 8 例.骨折部位:股骨中段骨折 15 例,股骨转子下骨折 11 例,股骨干骨折合并股骨颈骨折 8 例,多段骨折 4 例.22 例采用闭合复位、16 例采用有限切开复位,顺行插入 A2FN 固定.结果 手术时间为 50~120 min,平均70 min;术中出血 120~600 ml,平均 220 ml.本组术后获 10~22 个月随访,平均 15.1 个月,骨折全部愈合,骨折愈合时间为 16~32 周,平均 20.2 周.患者术后均恢复正常生活,无内固定松动、感染、脂肪栓塞等并发症发生.根据膝关节功能评分标准 ( hospital for special surgery,HSS ),优 25 例,良 10 例,中 3 例,优良率 92.1%.术后髋关节 Harris 评分平均 91 ( 80~96 ) 分.结论 A2FN 治疗股骨骨折能有效地维持骨折端稳定性,更符合国人髓腔解剖,具有手术创伤小、操作简便、并发症少的优点,尤其适用于股骨干合并股骨近端骨折.