术中尖顶距控制在PFNA内固定治疗中的应用研究

摘要

Objective To analyze the application of intraoperative controlled tip-apex distance (TAD) in treatment of femoral intertrochanteric fracture with proximal femoral nail antirotation (PFNA ).M ethods There were 51 patients received internal fixation with PFNA. We measured and analyzed the intraoperative approximate TAD,postoperative TAD and TAD of six months after operation.Results All bone union achieved after 14. 4 weeks. Excellent rate of Harris score was 91. 3% ,and the average Paker scorewas 8. 09 six months after operation. Average of intraoperative approximate TAD was 22. 23± 2. 18 mm (16. 24 mm~ 27. 17 mm) ,and the average of postoperative TAD was 21. 09± 2. 60mm (15. 38mm~ 26. 82mm) , and there was significant correlation between of datatwo groups (r= 1.25,P< 0.001). Average of TAD of six months after operation was 20.23± 2.45 mm(15. 97 mm~ 26.33 mm),and there was no significant difference comparing to postoperative TAD(P> 0. 05). Conclusion For operation with PFNA ,we can get intraoperative approximate TAD to prevent relative complications such as helical blade cutting-out of femoral head.%目的 研究术中控制尖顶距(tip apex distance,TAD)在抗旋转股骨近端髓内钉(proximal femoral nail antirotation,PFNA)治疗股骨粗隆间骨折中的应用.方法 对51 例股骨粗隆间骨折患者行闭合复位PFNA内固定术,术中应用测量缩放比例控制最佳的TAD近似值,并测量术后首次的TAD值、术后6个月复查的TAD值,将各结果进行对比分析.结果 46 例患者获得随访,随访时间6～22个月,平均13个月.随访患者骨折全部愈合,愈合时间平均14.4周,术后6个月髋关节功能Harris评分优良率91.3%,Parker评分平均8.09分.术中测得尖顶距近似值为16.24～27.17 mm,平均(22.23±2.18) mm.术后标准方法测得尖顶距为15.38～26.82 mm,平均(21.09±2.60) mm,行两变量Pearson相关分析有显著的相关性(r＝1.25,P＜0.001).术后6个月测得尖顶距15.97～26.33 mm,平均(20.23±2.45) mm,与术后TAD比较无显著性差异(P＞0.05).结论 PFNA治疗股骨粗隆间骨折,术中通过测量缩放比例控制最佳的TAD近似值,对预防螺旋刀片切割、穿出股骨头有重要意义.