粗隆间骨折依固定方式分为髓内固定与髓外固定，其中又以股骨近端髓内钉系统为主流。传统股骨近端髓内钉常见并发症包括退钉、髋内翻等，为避免上述并发症，国外学者研究一种带“爪”髓内钉，其在股骨头锁钉及髓腔远端均有爪形分支，可自动张开或回缩。其具体内容及临床应用结果发表在2020 Injury期刊上。

Background（背景）

远端带爪股骨近端髓内钉(Talon-PFN)是一种用于治疗股骨转子间骨折的新型股骨近端髓内钉。本研究旨在报告采用新型股骨近端髓内钉治疗患者的临床和影像学结果。

[Background: The TalonTM DistalFixTM Proximal Femoral Nail (Talon-PFN) is a new proximal femoral intramedullary nail designed for the treatment of intertrochanteric femoral fractures. This study aimed to report the clinical and radiological outcomes of patients treated using a proximal femoral intramedullary nail with a novel design.]

 

Methods（方法）

我科于2014年10月至2018年1月使用Talon-PFN治疗的稳定或不稳定(AO/OTA型31-A1，2，3)股骨转子间骨折患者参加了这项回顾性研究。评估患者的人口统计学数据、临床特征、功能和影像学结果。

[Methods: Patients with either stable or unstable (AO/OTA type 31-A1, 2, 3) intertrochanteric fractures who were treated with the Talon-PFN between October 2014 and January 2018 in our department participated in this retrospective study. Patients’ demographics, clinical characteristics, and functional and radiographical outcomes were evaluated.]

图1：Talon髓内钉示意图。可见髓内主钉远端及股骨颈钉均有爪形突出。

附：该髓内钉的置入顺序为先置入髓内钉主钉，后将主钉远端爪形结构张开，稳定后，置入股骨颈头钉，后将头顶爪形结构张开。

Results（结果）

共有110名患者(65名女性，45名男性)参与了这项研究，平均年龄80.6±9.1岁，平均随访时间24±13.4个月。随访期间总死亡率为50.48%。最常见的围手术期并发症是股骨颈螺钉移位和爪切割，两者在17例患者中均发生(15.5%)。随访期间观察到的最常见并发症为小转子骨不连/畸形愈合34例(30.9%)，外翻畸形愈合18例(16.4%)，螺钉侧移4例(3.6%)，内翻畸形愈合15例(13.7%)。4名患者(3.6%)出现了股骨头晚期螺钉切出。53例患者至少发现一种并发症(48.2%)。然而，只有6例(5.5%)进行了翻修手术。

[Results: A total of 110 patients (65 females, 45 males) with a mean age of 80.6 ± 9.1 years participated in this study. The mean follow-up time was 24 ± 13.4 months. The overall mortality rate during followup was 50.48%. The most common perioperative complications were a malposition of the femoral neck screw and talon cutout, both of which occurred in 17 patients (15.5%). The most common complications observed during follow-up were a lesser trochanter nonunion/malunion in 34 patients (30.9%), valgus malunion in 18 patients 16.4%), lateral screw migration in four patients (3.6%), and varus malunion in 15 patients (13.7%). A late screw cutout through the femoral head was seen in four patients (3.6%). At least one complication was detected in 53 patients (48.2%). However, revision surgery was performed in only six of these cases (5.5%).]

图2：临床病例示意图。

表1：纳入病例基线资料。

 

表2：并发症和术后功能。

图3：术后见爪形结构切出。

Conclusion（结论）

根据本研究获得的结果，与其他股骨近端髓内钉设计相比，Talon-PFN具有相似的临床和影像学结果，可以作为治疗股骨转子间骨折的合适替代方案。

[Conclusion: According to the results obtained in this study, the Talon-PFN, which has similar clinical and radiological outcomes compared to other proximal femoral intramedullary nail designs according to the reported studies, can be a suitable alternative in the treatment of intertrochanteric fractures.]