这种新型“带爪”髓内钉，能否有效固定粗隆间骨折？

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: 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: 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。

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。

[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.]