尖顶距在股骨近端抗旋转髓内钉治疗股骨近端骨折中的应用

目的:探讨尖顶距在股骨近端抗旋转髓内钉治疗股骨近端骨折临床效果中的作用和意义,为骨外科手术疗效的评价提供可借鉴的方法。方法:对2006年8月-2007年10月期间在我院接受PFNA治疗的32例股骨近端骨折患者的临床资料进行回顾性分析。根据AO/ASIF国际内固定研究学会标准对骨折进行分类,应用术中和术后即刻X光射线照片对骨折复位情况、远端锁定类型和股骨头内刀片位置进行记录。患者术后常规X光照片观察切出情况,用Oxford髋关节评分系统评价临床疗效。结果:研究期间共有37例PFNA植入,纳入本研究的共32例,27例获得随访。其中,3例切出(2例内侧穿孔和1例内侧塌陷)TAD小于20mm。4例植入相关股骨骨折,2例不愈合,1例复位失败。结论:PFNA是治疗股骨近端不稳定型骨折的有效装置。我们认为TAD应尽量20 mm或30 mm以避免股骨头穿透。

Application of TAD on the Treatment of Proximal Femoral Fractures by the Proximal Femoral Nail Antirotation

Objective:To explore the application and significance of TAD on the treatment of proximal femoral fractures by PFNA in order to make a reference for clinical research.Methods:A retrospective analysis was performed about the clinical data of 32 patients with proximal femoral fractures who were treated by PFNA in our hospital from August 2006 to October 2007. The international standards for the study of internal fixation with AO/ASIF was used to classify the types of fractures, the intraoperative and postoperative immediate X-ray photographs of fracture were applied to record the distal locking blade position, the type and the femoral head. The conventional X-ray was performed to observe the postoperative cut out, and the Oxford hip grading system was meant to evaluate the clinical effect.Results:32 patients were enrolled in the study among which there were 27 cases followed up. 3 cases presented the cut out (2 cases of medial perforation and 1 case of medial collapse) with the TAD<20 mm. 4 cases were implanted into the related femoral fractures, 2 cases not healing, and 1 case of reset failed.Conclusion:It is suggested the PFNA should be an effective device for the treatment of unstable proximal femoral fractures. However, the blade distance should be in TAD<20 mm or TAD>30 mm so as to avoid the penetration of femoral.