开口锥股骨近端扩髓技术在PFNAⅡ手术中的应用

摘要

Objective To evaluate the efficacy of direct proximal reaming with a reamer to treat intertrochanteric fracture in proximal femoral nail antirotation II ( PFNAII) surgery.Methods A total of 20 patients with intertrochanteric fracture were treated, where their intertrochanteric fractures were closed and fixed through insertion of PFNAⅡ at the proximal portion of the fermur by a reamer.Then, their operation time, intraoperative blood loss, the times of X-ray ra-diography, the time of fracture healing and Harris hip scores.Results Their operation time was (37.6 ±9.3) min, the intraoperative blood loss was (43.5 ±29.9) ml, and the times of X-ray radiography was (9.0 ±2.9) times.All pa-tients were followed-up visited for 8 to 21 months, with an average of (13.4 ±4.6) months.All fractures were cured within 10 to 22 weeks, with an average of 15.4 weeks.For the postoperative Harris score, 9 patients were excellent and 7 were good, with a total excellent to good rate of 80%.No infection was reported.No complication was found, such as coxa vara, external rotation, shortening deformity, insertion of spiral blades into the femoral head, internal fixation failure or delayed fracture healing.Conclusions Direct proximal reaming with a reamer to treat intertrochanteric fracture in PFNAII surgery can reduce the operation time and intraoperative blood loss, making PFNAⅡ procedures simpler and more effective.%目的：探讨采用开口锥对股骨近端直接扩髓技术，用于股骨近端防旋髓内钉（ PFNA）Ⅱ手术治疗股骨转子间骨折的临床疗效。方法选择20例股骨转子间骨折的患者，将转子间骨折闭合复位后，采用开口锥对股骨近端扩髓后置入PFNAⅡ主钉。记录平均手术时间、术中出血量、术中透视次数、骨折临床愈合时间、术后髋关节Harris评分等。结果20例患者的手术时间、术中出血量和术中透视次数分别为（37．6±9．3） min、（43．5±29．9）ml、（9±2．9）次。所有患者均获得随访，时间8～21个月，平均（13．4±4．6）个月。骨折均愈合，时间10～22周，平均15．4周。术后Harris评分：优9例，良7例，优良率为80％。均未出现感染、髋内翻畸形、下肢外旋及短缩畸形、螺旋刀片切割股骨头、股骨干骨折、内固定失效及延迟骨折愈合等并发症。结论采用开口锥股骨近端扩髓技术行PFNAⅡ手术，可减少手术时间和术中出血量，简化PFNA的操作步骤，使PFNA的操作更加简单有效。