目的 随着头髓钉治疗老年股骨粗隆间骨折的逐渐推广, 临床上插钉困难、固定不满意者也并不少见。本文探讨使用亚洲型股骨近端防旋髓内钉(PFNA II)治疗老年股骨粗隆间骨折的手术技巧。方法 通过总结自身的经验体会并复习文献资料, 总结出涉及手术顺利成功的10条经验。结果 包括患者在手术台上的体位摆放、入钉点内移至大粗隆顶点内侧壁、导针尖端弯曲成角、扩髓时手部顶压防止撑开效应、手工轻旋插入、用TAD控制股骨头内的螺旋刀片位置、注意股骨前弓与钉尖的撞击, 注意钉尾突出高度、在身材矮小的老年肥胖女性准备侧板固定系统等。结论 重视头髓钉的结构特点与手术技巧, 有利于提高插钉成功率与固定质量。
Objective Cephalomedullary nails are becoming more and more popular in the treatment of per/inter-trochanteric fractures.However,difficulties in nailing process and unsatisfied fixation are not so rare in clinic.Our purpose is to investigate the technical tips and skills with proximal femoral nail antirotation Asian version (PFNA-II).Methods Through summary of our experiences and lessons,with review of related literatures,we gather ten tips regarding successful nail insertion and stable fixation.Result These include patient position in fracture table,medial shift of entry point from the exact trochanteric tip,use of laterally curved guide wire,hand press over lateral wall to avoid wedge opening effect,hand insertion of nail without hammer blow,use TAD to control the position of helical blade in femoral head,awareness of the impingement between femoral anterior cortex and nail tip,awareness of the prominence of proximal nail end,and last,prepare side-plate instrument for obese female with short stature.Conclusion Paying attention to the structure chaeacteristic of cephalomedullary nail and technical skill can improve the nailing success rate and fication quality.
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