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首页> 外文期刊>Open Journal of Urology >Proximal Femoral Nailing: Technical Difficulties and Results in Trochanteric Fractures
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Proximal Femoral Nailing: Technical Difficulties and Results in Trochanteric Fractures

机译：股骨近端钉：股骨转子骨折的技术难题和结果

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Background: Proximal femoral nailing in communited intertrochanteric fractures is increasingly becoming popular in view of superior biomechanics and prevention of varus collapse associated with Dynamic hip screw. However, technical difficulties and implant related complications have been described with this technique, thus we need more studies to address these issues. Our study aims to understand technical difficulties involved in proximal femoral nailing, and specifically analyses neck shaft angle at follow-up indicating varus collapse and also to compare results of stable and unstable fractures. Materials and Methods: In this study, patients who presented to the Orthopedic Unit of Dr. TMA Pai Hospital (An associated hospital of Manipal University, Manipal) with trochanteric fractures included and treated with proximal femoral nailing. The technical difficulties involved with surgical procedure and techniques adapted to overcome such difficulties were recorded. All patients were followed up for a period of 2 years and final outcome assessment included the number of shortening, neck shaft angle and harris hip score. Results: 41 patients (mean age 71) who underwent proximal femoral nailing from January 2004 to December 2009 were included in the study, 38 patients completed 2-year follow-up. The technical difficulties we faced were divided into 3 categories, difficulties in securing entry point and guide wire placement especially when greater trochanter and piriform fossa were gathered, reduction was lost while passing nail, and finally difficulties faced during placement of hip screws. In all except one, neck shaft angle of more than 130 degrees was achieved, and this was also maintained in the final follow-up (Mean 131.9 degrees). All fractures were united, with mean shortening of 2 mm. Conclusions: Although PFN is technically required, with a proper technique PFN gives excellent clinical results with almost negligible varus collapse even in unstable trochanteric fractures. Regarding the techniques, reaming the proximal part of femur adequately and observing the nail passage with image carefully are important in placing the nail correctly, while, placement of lag screw in the inferior part of neck in anterior posterior projection and central in lateral projection reduces risk of implant failure.
机译：背景：鉴于优越的生物力学和预防与动力髋螺钉相关的内翻塌陷，在股骨转子间骨折中股骨近端钉正变得越来越流行。然而，这种技术已经描述了技术难题和与植入物相关的并发症，因此我们需要更多的研究来解决这些问题。我们的研究旨在了解股骨近端钉扎所涉及的技术难题，并在随访中特别分析颈轴角度以指示内翻塌陷，并比较稳定和不稳定骨折的结果。材料和方法：在本研究中，包括就诊为TMA Pai医院（马尼帕尔大学，马尼帕尔大学附属医院）骨科的股骨转子骨折并接受股骨近端钉扎治疗的患者。记录了与外科手术有关的技术困难和克服这些困难的技术。所有患者均接受了为期2年的随访，最终结果评估包括缩短的次数，颈轴角度和harris髋关节评分。结果：从2004年1月至2009年12月对41例患者（平均年龄71岁）进行了股骨近端钉扎，其中38例患者完成了2年的随访。我们面临的技术难题分为三类，特别是当聚集了更大的转子和梨状窝，在钉子钉钉时损失减少以及最后在放置髋螺钉时遇到的困难，难以确保进入点和导丝的放置。除一个以外，其他所有颈部颈部角度均超过130度，并且在最终的随访中也保持这一角度（平均131.9度）。所有骨折均合并，平均缩短2 mm。结论：尽管PFN在技术上是必需的，但采用适当的技术，即使在不稳定的股骨转子骨折中，PFN也可提供出色的临床效果，内翻塌陷几乎可以忽略不计。关于技术，适当地扩股股骨近端并仔细观察图像的指甲通道对于正确放置指甲非常重要，而将拉力螺钉放置在颈后部的前部后部投影和中心部在侧部投影可降低风险植入失败的原因。

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