股骨粗隆间骨折PFNA内固定失效手术因素分析

doi:10.13418/j.issn.1001-165x.2020.06.020

Abstract

Abstract: Objective　To investigate the operative factors of failure in femoral intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA).　Methods　The material of patients with intertrochanteric fracture who accepted fixation with PFNA were conducted from September 2015 to September 2018 in our hospital and were analyzed retrospectively. Patients who failed in PFNA fixation were 24. Preoperative lateral wall fracture, postoperative reduction mass of medial femoral trochanteric cortex, region of spiral blade located on X-ray film, and the tip-apex distance (TAD) were observed through the X-ray film of preoperative, postoperative and internal fixation failure.　Results　In the 24 cases who failed in PFNA fixation, 13 cases (accounting for 54%) had lateral wall fractures before operation, 5 cases had dangerous lateral wall fractures, and 6 cases had no lateral wall fractures. While there were 16 cases (accounting for 67%) of medial cortical reduction negative support, 6 cases of positive support and 2 cases of neutral support. At the same time, there were 16 cases (accounting for 67%) with TAD>25 mm, 6 cases with TAD between 10mm~25mm, 2 cases with TAD<10 mm. In the region of spiral blade located on the positive X-ray film, there were 19 cases (accounting for 79%) located on the upper side, 3 cases in the middle-lower side and 2 cases in the lower side. In addition, in the lateral X-ray film, there were 17 cases (accounting for 71%) located in the front side, 5 cases in the back side, and 2 cases in the middle side.　Conclusions　The risk of internal fixation increase when there were lateral wall fractures before operation, poor medial cortex reduction, oversize TAD and poor location of spiral blade on the X-ray film in the femoral intertrochanteric fracture fixed with PFNA.

Key words: Femoral intertrochanteric fracture, 　Proximal femoral nail anti-rotation (PFNA), 　Failure of fixation

CLC Number:

R687.3

NIU Guo-qing, WU Feng, PENG Zhi-hao, LU Guo-liang, HUO Zhi-qian . Analysis of surgical factors of failure of PFNA after intertrochanteric fracture[J]. Chinese Journal of Clinical Anatomy, 2020, 38(6): 728-734.

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Analysis of surgical factors of failure of PFNA after intertrochanteric fracture

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