Gamma钉与重建钉内固定治疗老年转子间骨折的比较

Comparison of Gamma Nails and Reconstruction Nails in Intramedullary Fixation for Intertrochanteric Hip Fractures in the Aged

目的:比较Gamma钉与重建钉治疗老年转子间骨折的手术过程、并发症与临床疗效。方法:对2004年8月—2007年4月,髓内固定手术治疗83例老年转子间骨折的临床资料进行回顾分析。其中Gamma钉固定治疗55例,重建钉固定治疗28例,患者平均年龄75.8岁(61～89岁),开始负重平均时间3.3个月(0.5～8.0个月),平均随访19.2个月(6～35个月)。比较两组患者一般资料、手术过程、并发症与临床疗效。结果:重建钉固定组术后住院时间与手术时间比Gamma钉固定组长(P=0.047;P<0.001),术中出血量比Gamma钉固定组多(P=0.011)。83例患者术后获随访平均19.2个月(6～35个月)。术后1年内14例患者出现并发症,包括切口感染、心肌梗死等,Gamma钉固定组与重建钉固定组的差异无统计学意义(P=0.537)。本组83例患者的骨折全部临床愈合,未出现内固定失败、断裂;两种髓内固定方法总体优良率83.1%,Gamma钉固定组与重建钉固定组优良率分别为85.5%与78.6%,两组优良率差异无显著性(P=0.428)。结论:Gamma钉与重建钉都适合于治疗转子间骨折,对于不能早期负重功能锻炼的老年患者,Gamma钉具有创伤小、手术时间短与术中出血少的优点。

Objective：To study the clinical outcomes of intramedullary fixation for intertrochanteric fractures in aged patients with Gamma nails and reconstruction nails. Methods： A retrospective analysis was conducted for the 83 patients who had been treated in our hospital for intertrochanteric fractures from August 2004 to April 2007. Of them, 55 cases were treated with Gamma nails and 28 cases with reconstruction nails. Their average age was 75.8 （61-89） years, mean time to start weight bearing 3.3 （0.5-8.0） months and mean time of follow-up 19.2 （6-35） months. The pre-operation data, operation process,complications and post-operative function of all the cases were evaluated. Results： The average hospitalization after operation , operating time and intraoperative blood loss of Gamma nail fixation group are less than that of reconstruction nail fixation group （14.2±3.0 days vs. 15.6±3.0 days,P =0.047; 78.6±20.0 min vs. 124.8±31.3 min,P =0.000; 160.2±100.5 mL vs. 225.4±122.2 mL, P = 0.011 ）. As for cases achieved good to excellent functional evaluation, there was no statistical difference between Gamma nail fixation group and reconstruction nail fixation group （85.5 % vs. 78.6 %, P = 0. 428）. Conclusion： Both Gamma nail and reconstruction nail fixations were fit for intertrochanteric fractures in aged patients, Gamma nail fixation has advantages of less operating time and blood loss, and shorter hospitalization.