Gamma钉与锁定钛板修复老年不稳定型股骨转子间骨折:髋关节功能对比

Gamma nail versus locking titanium plate fixation for unstable intertrochanteric fracture in the elderly:hip function

背景:随着股骨转子间骨折内固定方式选择的多样化,同一种类型骨折的内固定方式往往根据术者的习惯选择,无统一标准。目的:比较Gamma钉和股骨近端解剖锁定钛板置入内固定修复老年不稳定型股骨转子间骨折的优劣。方法:武警山西总队医院2009年4月至2012年9月对94例老年不稳定型股骨转子间骨折行内固定治疗,根据内固定方案分为两组,其中Gamma钉组46例,股骨近端锁定板组48例。从切口长度、术中出血量、手术时间、治疗后髋关节功能恢复情况、负重时间及并发症等方面对两种内固定方法进行对比分析。结果与结论:两种内固定方式在切口长度、术中出血量、治疗后负重时间及并发症方面比较,Gamma钉优于股骨近端锁定板,差异有显著性意义(P<0.05);两组患者手术时间差异无显著性意义(P>0.05)。治疗后1年髋关节功能Gamma钉组优良率为96%(44/46),股骨近端锁定板组优良率为92%(44/48),两组差异无显著性意义(P>0.05)。提示Gamma钉和股骨近端解剖锁定钛板置入内固定修复不稳定型股骨转子间骨折均能实现良好的髋关节功能恢复,但Gamma钉在切口长度、术中出血量、治疗后并发症及负重时间等方面优势明显。

BACKGROUND：With the diversification of the choice of internal fixation for femoral intertrochanteric fracture, the fixation method for the same kind of fracture can be selected according to surgeon’s habit, and there is no unified standard. OBJECTIVE：To compare Gamma nail and proximal femoral locking plate fixation for repair of femoral intertrochanteric fractures. METHODS： A total of 94 elderly patients with unstable intertrochanteric fractures were treated in the Shanxi Armed Police Corps Hospital from April 2009 to September 2012. They were divided into two groups according to fixation methods. Gamma nail group contained 46 cases. Proximal femoral locking plate group contained 48 cases. The two fixation methods were compared and analyzed from the folowing aspects： incision length, intraoperative bleeding volume, operation time, postoperative hip function recovery, loading time and complications. RESULTS AND CONCLUSION：Incision length, intraoperative bleeding volume, loading time and complications were better in the Gamma nail group than in the proximal femoral locking plate group （P 〈 0.05）. No significant difference in operation time was detected between the two groups （P 〉 0.05）. The excelent and good rate of hipnbsp;function was 96% （44/46） in the Gamma nail group and 92% （44/48） in the proximal femoral locking plate group at 1 year after treatment, and no significant difference was detectable between the two groups （P 〉 0.05）. These findings suggest that Gamma nail and proximal femoral anatomic locking plate for the treatment of unstable intertrochanteric fractures can reach good recovery of hip function, but Gamma nail showed obvious advantages in incision length, intraoperative bleeding volume, loading time and complications.