股骨粗隆间骨折行股骨近端防旋髓内钉内固定术后失败的原因分析及手术经验总结

摘要

目的 通过分析老年股骨粗隆间骨折患者行股骨近端防旋髓内钉(PFN-A)手术病例,总结PFN-A手术疗效、失败原因及治疗经验.方法 选取我院2013年1月至2017年3月股骨粗隆间骨折患者105例,均行PFN-A手术,统计手术时间、出血量,运用髋关节创伤后Harris功能评分,分析PFN-A内固定失败原因,总结手术经验.结果 手术时间为50～135min,平均(87.27±40.08) min;术中出血量50 ～ 200mL,平均(107.69±43.17)mL;术后Harris评分,其中优59例,良28例,中15例,差3例,优良率82.86％;内固定失败2例,1例主钉断裂,1例螺旋刀片穿出股骨头.结论 PFN-A内固定手术失败最主要因素是骨折复位欠佳和手术操作因素,其次术后负重时间过早和患者自身体质过重、严重骨质疏松,但PFN-A内固定术仍为老年股骨粗隆间骨折患者的首选术式.%Objective To analyze the clinical results of Proximal Femoral Nail Antirotation (PFN-A)in senile patients with femoral intertrochanteric fractures and to summarize the failure causes and treatment experience of PFN-A.Methods A total of 105 patients with femoral intertrochanteric fractures treated in our hospital with PFN-A surgery from January 2013 to March 2017 were enrolled in this study.The duration of operative,bleeding volume and Harris functional score after hip trauma were calculated.Then we fix the cause of failure and summarize the surgical experience.Results The duration of operation was 50 ～ 135min,the average of which was (87.27 ± 40.08)min.The intraoperative blood loss was 50 ～200mL,with an average of(107.69 ± 43.17) mL.The postoperative Harris score was excellent in 59 patients,good in 28 patients and moderate in 15 patients,while 3 cases got poor scores.Excellent and good rate was 82.86％.2 cases failed in internal fixation,one of which had primary nail fracture and the screw blade of the other screwed out of femoral head.Conclusion The main factors of PFN-A internal fixation failure were the poor fracture reduction and operative factors,followed by premature weight-bearing,weight factorsand severe osteoporosis.However,the PFN-A internal fixation is the first choice for senile patients with femoral intertrochanteric fractures.