摘要
目的 观察亚洲型股骨近端防旋髓内钉（PFNA-Ⅱ）与国人股骨前弓的匹配性,并提出设计改良方法.方法 回顾性分析2009年8月至2010年12月收治的158例股骨转子间骨折PFNA-Ⅱ内固定术后患者（男35例,女123例；平均年龄为77.2岁）的侧位X线片,采用自创的6级分类法：0级：位于髓腔中央,1级：偏斜、但与皮质无接触,2级：有接触、＜皮质厚度的1/3,3级：＞皮质厚度的1/3、但＜2/3,4级：＞皮质厚度的2/3,5级：从皮质穿出,所有级别向前偏斜为“＋”,向后偏斜为“-”.观察头髓钉的远端钉尖与股骨前侧皮质的关系；测量将前突的钉尖置于髓腔中央时所需后移的距离；并计算弧形头髓钉所对应的弧度和弧度半径. 结果 158例患者中PFNA-Ⅱ远端钉尖位于髓腔中央者30例（19.0％）,偏前（1～3级）者118例（74.7％）,偏后（-1级）者10例（6.3％）.在偏前的118例患者中有55例远端钉尖与股骨前侧皮质有接触刺激（2 ～3级）.在钉长为17、20、24 cm的短钉中,将前突的钉尖置于髓腔中央时所需后移的距离平均分别为（1.42±0.18）、（1.77±0.39）和（2.46±0.20）mm,所对应的髓内钉向后弯曲弧度平均分别为2.51°±2.40°、2.13°±1.65°和2.09°±0.98°,所对应的弧形头髓钉弯曲半径平均分别为（1483±818）、（2329±1293）和（3710±1957） mm.结论 目前临床使用的PFNA-Ⅱ与国人的股骨前弓并不匹配,其短钉型号（钉长≤24 cm）亦需弧形设计,才能更适合国人股骨前弓的形状.
Objective To observe the matching between the straight short femoral cephalomedullary nail （PFNA-Ⅱ） and the femoral anterior bow in Chinese patients with intertrochanteric fracture. Methods A retrospective study was performed to analyze the postoperative lateral X-rays of 158 patients with intertrochanteric fracture who had been treated by PFNA- Ⅱ between August 2009 and December 2010.They were 35 men and 123 women,with a mean age of 77.2 years.The relationships between the distal tip of the medullary nail and the anterior cortex of the femur were observed according to a self-designed 6-grade scale （grade 0：central location of the nail tip in the medullary canal; grade 1：deviated location without contact with the cortex; grade 2：contact 〈 1/3 cortex thickness; grade 3：contact 〉 1/3, 〈 2/3 cortex thickness; grade 4：contact 〉 2/3 cortex thickness; grade 5：perforation; posterior deviations in grades 1 to 5 presented as minus）.The theoretical distance was measured as if the anterior protrusive nail tip had been placed back to the central axis.The degree of the curvature and its corresponding radius were calculated by the geometric method. Results Of the 158 patients,the distal tip of PFNA- Ⅱ was located centrally along the axis of femur canal in 30 cases（19.0% ）,posteriorly to the central axis in 10 cases（6.3% ）,and anteriorly to the central axis in 118 cases （grades 1 to 3; 74.7% ）,of which 55 cases experienced irritation caused by the contact between the distal tip and the anterior cortex （grades 2 to 3% ）.The mean theoretical distance needed to put back the nail tip to the canal central axis was 1.42 ± 0.18 mm in the 17 cm nails,1.77 ± 0.39 mm in the 20 cm nails,and 2.46 ±0.20 mm in the 24 cm nails.Their corresponding curvature arcs were 2.51° ±2.40°,2.13° ± 1.65° and 2.09° ± 0.98°,and their curvature radii were 1483 ± 818 mm,2329 ± 1293 mm,and3710 ± 1957 mm,respectively. Conclusions There is a significant mismatch between the current short straight celphalomedullary nail （PFNA- Ⅱ） and the femoral anterior how in Chinese population.A curvature design is needed for the short cephaiomedullary nails to match the femoral anterior how of Chinese population.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2012年第2期103-107,共5页
Chinese Journal of Orthopaedic Trauma
关键词
髋骨折
骨钉
股骨
Hip fractures
Bone nails
Femur
作者简介
通信作者：张世民，E-mail：shiminchang@yahoo．com．cn
