Gamma-3钉与防旋型股骨近端髓内钉(PFNA)治疗股骨粗隆间骨折的疗效比较

Comparison of PFNA and Gamma 3 nail in the treatment of femoral intertrochanteric fracture

目的 探讨Gamma-3钉与防旋型股骨近端髓内钉（PFNA）治疗股骨粗隆间骨折的临床疗效。方法 回顾性分析2010年6月～2014年6月治疗的36例股骨粗隆间骨折患者资料,男性20例,女性16例;年龄35～82岁,平均（58.4±10.8）岁。其中20例行PFNA内固定手术,16例行Gamma-3钉治疗,术后对两组手术临床指标、功能评分和并发症进行统计比较。结果 PFNA组手术用时（63.5±21.4）min、透视次数（8.5±4.4）次、出血量（120.4±21.5）m L,结果显著性低于Gamma-3钉组的（79.6±15.8）min、（10.8±3.5）次、（180.9±56.6）m L;PFNA组切口长度为（7.3±2.4）cm与Gamma-3钉组的（6.6±2.1）cm差异无统计学意义;PFNA组骨折的愈合时间和髋关节功能评分分别为（10.9±3.1）周和（88.6±11.4）分,与Gamma-3钉组的（12.2±1.9）周、（84.5±15.3）分差异无统计学意义;两组手术均未出现骨不连、内固定断裂及切出股骨头等并发症,无再次骨折发生,并发症差异无统计学意义。结论 与Gamma-3钉内固定术相比,PFNA内固定术具备固定可靠、术中射线暴露少、术中出血少、手术时间短等优势,值得临床推广与应用。

Objective To investigate the efficacy of proximal femoral nail anti - rotation （ PFNA ） and the Gamma 3 nail in the treatment of femoral intertrochanteric fractures. Methods Totally 36 cases of femoral intertrochanteric fractures in our hospital from Jun. 2010 to Jun. 2014 were selected, including 20 males and 16 females, with an average age of （ 58.4 ± 10. 8 ） years （ ranging from 35 to 82 years ）. Among them,20 patients were treated by PFNA internal fixation and 16 cases were treated with Gamma 3 nail. Surgical effects,postoperative functional scores and complications were compared between the two groups. Results The operation time, fluoroscopy times and blood loss in the PFNA group were （ 63.5 ± 21.4 ） rain, （ 8.5 ± 4. 4） times and （ 120. 4 ± 21.5 ） ml , respectively, which were significantly lower than those of the Gamma 3 nail group [ （ 79. 6 ± 15.8 ） min, （ 10. 8 ± 3.5 ） times, （ 180.9 ± 56.6 ） mL]. The length of incision in the PFNA group and Gamma 3 nail group was （7.3 ±2.4 ） cm and （ 6. 6 ± 2. 1 ） cm, respectively, indicating no significant statistical difference. The hip score and fracture healing time of the PFNA group were [ （ 88.6 ± 11.4 ） points and （ 10. 9 ± 3. 1 ） weeks ], respectively, which had no statistical difference with the Gamma 3 nail group （ 84. 5± 15.3 ） points and （ 12. 2 ± 1.9 ） weeks. Neither group developed surgical cutting of the femoral head, fixation breakage, nonunion or other complications. Conclusion Compared to Gamma 3 nail fixation,PFNA has advantages of shorter operation time,less intraoperative bleeding and less intraoperative X-ray exposure,which is worthy of clinical promotion and application.