3型伽马钉治疗老年股骨转子间骨折

Type-three intramedullary gamma nail for treatment of aged intertrochanteric fracture in the elderly

[目的]探讨3型伽马钉（γ-3）治疗老年股骨转子间骨折的临床疗效。[方法]回顾性分析用γ-3治疗122例老年股骨转子间骨折的临床疗效,平均年龄77.6岁,91.8%合并股骨近端严重骨质疏松,术中牵引复位,微创置入γ-3,术后进行骨质疏松治疗,对比术后即刻及随访期末的颈干角及尖顶距,并行Harris髋关节功能评分。[结果]随访时间平均14.2个月（12～18个月）,平均住院时间11.4 d,平均手术时间54 min,患肢完全负重及骨折愈合时间平均11.2周,Harris髋关节功能评分平均86.1分,其中优60例,良52例,可10例,共9例发生术后并发症。术后次日所测股骨颈干角及尖顶距与随访期末所测值之间差异无统计学意义。[结论]3型伽马钉治疗老年股骨转子间骨折创伤小、疗效可靠、并发症少,是高龄股骨转子间骨折的有效治疗方法。

[Objective] To evaluate the efficacy of Type - three Gamma nail （γ -3 ） in the treatment of intertrochanteric fractures of elderly patients.[ Method] A total of 122 aged patients with intertroehanteric fractures were treated with γ-3 nail. The average age was 77.6 years. In all the cases,91.8 percent had severe osteoporosis in the proximal end of femoral. After re- duction, the fractures were fixed with γ-3 nail minimal invasivelly. All the eases were followed up for 12 to 18 months, and os- teoperosis were treated with bisphosphonates and vitamin D. The femoral neck - shift angle and tip - apex distance were meas- ured and compared immediately after operation and at the final follow- up. Harris hip score was assessed. [ Result] The average operating time was 54 minutes and the average in - hospital time was 11.4 days. The average union time of the fractures was 11.2 weeks. The average Harris hip score as 86. I points. And based on this criteria, excellent outcome was achieved in 60 ca- ses, good in 55 cases and another 7 cases, showed fair results. Nine cases had postoperative complications. The femoral neck - shift angle and tip - apex distance were similar between immediately after operation and at final follow - up. [ Conclusion] Type - three Gamma nail internal fixation is an effective method in the treatment of aged intertroehanteric fracture patients, with cer- tain advantages of minimal invasion, reliable results and low rate of complications.