老年股骨粗隆间骨折PFNA-II插钉内固定的手术技巧

Abstract

Abstract: 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.

Key words: Proximal femoral fracture, Intertrochanteric fracture, Intramedullary nail fixation, Cephalomedullary nail, PFNA

CLC Number:

R 683.42

Zhu Xiao-Zhong, Zhang Shi-Min, Huang Yi-Gang, Wang Xin. Technical tips with the nailing of proximal femoral nail antirotation Asian version (PFNA-2) in the treatment of geriatric intertrochanteric hip fractures[J]. 外科研究与新技术, 2012, 1(2): 115-120.

References

[1] 张世民,袁锋,俞光荣.老年髋部骨折的临床治疗流程[J].中国矫形外科杂志,2005,13(18):1365-1368.
[2] 祝晓忠,张世民,王欣,等.老年股骨转子间骨折PFNA内固定的隐性失血[J].中国矫形外科杂志,2010,18(17):1423-1426.
[3] Russell TA,Sanders R.Pertrochanteric hip fractures:time for change[J].J Orthop Trauma,2011(4),25:189-190.
[4] Kokoroghiannis C,Aktselis I,Deligeorgis A,et al.Evolving concepts of stability and intramedullary fixation of intertrochanteric fractures-A review[J].Injury,2012,43(6):686-693.
[5] 张世民.股骨粗隆间骨折中外侧壁的概念及其临床意义[J].中国矫形外科杂志,2010,18(17):1489-1492.
[6] 张世民,祝晓忠,黄轶刚,王欣,张英琪,马卓.外侧壁危险型股骨粗隆间骨折DHS与PFNA治疗的回顾性对比研究[J].中国矫形外科杂志,2010,18(22):1868-1872.
[7] 马卓,张世民.股骨粗隆外侧壁研究进展[J].国际骨科学杂志,2012,33(4):221-224.
[8] Gotfried Y.The pantrochanteric hip fracture:an iatrogenic entity[J].J Orthop Trauma,2012,26(4):197-199.
[9] Aktselis I,Papadimas D,Fragkomichalos E,et al.Intramedullary nailing of trochanteric fractures-Operative technical tips[J].Injury,2012,43(6):961-965.
[10] Tyagi V,Yang JH,Oh KJ.A computed tomography-based analysis of proximal femoral geometry for lateral impingement with two types of proximal femoral nail anterotation in subtrochanteric fractures[J].Injury,2010; 41(8):857-861.
[11] Strauss E,Frank J,Lee J,et al.Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures:a biomechanical evaluation[J].Injury,2006,37(10):984-989.
[12] Born CT,Karich B,Bauer C,et al.Hip screw migration testing:first results for hip screws and helical blades utilizing a new oscillating test method[J].J Orthop Res,2011,29(5):760-766.
[13] Zhou JQ,Chang SM.Failure of PFNA:Helical blade perforation and tip-apex distance[J].Injury.2012; 43(7):1227-1228
[14] 宋德磊,张世民.亚洲型股骨近端防旋髓内钉与国人股骨前弓匹配性的影像学研究[J].中华创伤骨科杂志,2012; 14(2):103-107.
[15] Hwang JH,Oh JK,Han SH,et al.Mismatch between PFNa and medullary canal causing difficulty in nailing of the pertrochanteric fractures[J].Arch Orthop Trauma Surg,2008,128(12):1443-1446.
[16] Baumgaertner MR,Curtin SL,Lindskog DM,et al.The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip[J].J Bone Joint Surg AM,1995,77(7):1058-1064.
[17] 李双,王栋,张世民.尖顶距与股骨头内拉力螺钉切出的研究进展[J].中国矫形外科杂志,2007,15(19):1484-1485.
[18] Geller JA,Saifi C,Morrison TA,et al.Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures[J].Int Orthop,2010,34(5):719-722.
[19] Kuzyk PR,Zdero R,Shah S,et al.Femoral head lag screw position for cephalomedullary nails:a biomechanical analysis[J].J Orthop Trauma,2012,26(7):414-421.
[20] Haidukewych GJ.Intertrochanteric fractures:ten tips to improve results[J].J Bone Joint Surg Am,2009,91(3):712-719.

Technical tips with the nailing of proximal femoral nail antirotation Asian version (PFNA-2) in the treatment of geriatric intertrochanteric hip fractures

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 3

Recommended Articles

Metrics

Comments

[1]	. Clinical treatment analysis of PFNA in 98 cases of femoral intertrochanteric fracture with or without lateral wall fracture [J]. Surgical Research and New Technique, 2016, 5(1): 35-37.
[2]	. A comparison of the clinical efficacy of LCP and PFNA for surgical treatment of intertrochanteric fractures [J]. Surgical Research and New Technique, 2015, 4(1): 27-29,47.
[3]	ZHANG Li-zhi, ZHANG Shi-min, LI Qing, YAO Meng-wei, GUO Zhen, WU Xu, HU Sun-jun, DU Shou-chao. Head-neck fragment rotational displacement during wrenching-in lag screw in left-sided intertrochanteric fractures treated with Gamma-3 [J]. Surgical Research and New Technique, 2014, 3(1): 34-37.