加长型股骨近端抗旋髓内钉治疗股骨中上段长节段骨折临床研究.docVIP

加长型股骨近端抗旋髓内钉治疗股骨中上段长节段骨折临床研究 　　【摘要】 目的：评价采用加长型股骨近端抗旋髓内钉（long proximal femoral nail antirotation，PFNA-long）治疗股骨中上段长节段骨折的临床效果。方法：选取2012年1月-2016年12月本院采用加长型PFNA治疗股骨中上段长节段骨折20例，术后3、6个月采用Sanders髋关节创伤后功能评分系统评价临床疗效。结果：20例患者手术时间75～350 min，中位时间155 min；术中出血量50～700 mL，中位出血量168.5 mL。所有患者均获得随访，随访期间所有患者均未出现感染、螺旋刀片切割股骨头及断钉现象，无髋内翻短缩畸形出现，无骨折不愈合患者。骨折愈合时间为2～4个月，平均（2.96±0.54）个月。按Sanders髋关节创伤后功能评分标准：3个月优良率为80%，6个月优良率为90%。结论：加长型PFNA治疗方法具有微创、固定强度高、生物力学特性好等优点，在治疗股骨中上段长节段骨折时骨愈合率高、功能恢复快、并发症少。 　　【关键词】 股骨骨折； 骨折内固定术； 髓内； 股骨近端抗旋髓内钉 　　【Abstract】 Objective：To investigate the long proximal femoral nail antirotation（PFNA-long） in treatment of long-segment fracture in middle-up part of femoral shaft.Method：From January 2012 to December 2016，20 cases of long-segment fracture in middle-up part of femoral shaft were treated by fixation with PFNA-long.The clinical outcomes were evaluated acocording to Sanders’ traumatic hip rating scale at 3 months and 6 months after operation.Result：The operation time was 75-350 min，median time was 155 min，bleeding volume was 50-700 mL，median bleeding volume was 168.5 mL.All patients were followed up，during the follow-up period，no infection occurred in all patients，the femoral head and broken nails were cut by spiral blade，no hip varus deformity occurred，and no fracture nonunion occurred.All fractures healed after 2-4 months，mean （2.96±0.54）months.According to the Sanders hip trauma function score standard：the excellent and good rate was 80% in 3 months，the excellent and good rate was 90% in 6 months.Conclusion：PFNA-long is an effective and minimally invasive method for long-segment fracture in middle-up part of femoral shaft，with minimally invasive，high fixation-strength and accord with biomechanics characteristics，and with a high rate of bone union，early functional recovery and less complications. 　　【Key words】 Femoral fractures； Fracture fixation； Intramedullary； Proximal femoral nail antirotation 　　First-author’s address：Xinyi People’s Hospital，Xinyi 525300，Chi