倒置微创内固定系统与Gamma钉治疗伴外侧壁骨折股骨转子间骨折的疗效比较

Efficacy comparison of inverse less invasive stabilization system and Gamma nail for treatment of intertrochanteric fractures combined with lateral wall fractures

目的比较倒置微创内固定系统（LISS）与Gamma钉治疗伴外侧壁骨折不稳定股骨转子间骨折的临床疗效。方法采用回顾性对列研究分析2010年6月-2013年6月LISS倒置固定和Gamma钉内固定治疗的伴外侧壁骨折股骨转子间骨折且随访〉12个月的患者52例。根据内固定材料将患者分为两组：LISS倒置固定组24例，其中男16例，女8例；年龄（62．5±12．4）岁。按AO分型：A2．2型6例，A2．3型5例，A3．1型5例，A3．2型6例，A3．3型2例。Gamma钉固定组28例，其中男17例，女11例；年龄（60．4±18．6）岁。A2．2型4例，A2．3型7例，A3．1型9例，A3．2型5例，A3．3型3例。比较两组手术时间、总失血量、住院时间、骨折愈合情况、首次完全负重时间、并发症发生情况。采用Harris评分评价患者术后髋关节功能。结果所有患者获得随访24—36个月，平均30．2个月。Gamma钉固定组手术时间少于LISS倒置固定组（P〈0．05）；LISS倒置固定组总失血量少于Gamma钉固定组（P〈0．05）；两组患者住院时间、骨折愈合时间比较差异无统计学意义（P〉0．05）；LISS倒置固定组术后首次完全负重时间较Gamma钉固定组延长（P〈0．05）。术后1年LISS倒置固定组Harris评分[（86．1±12．4）分]与Gamma钉固定组[（83．3±11．2）分]比较差异无统计学意义（P〉0．05）。LISS倒置固定组髋内翻1例，骨折不愈合1例；Gamma钉固定组螺钉断裂1例，股骨头坏死1例，两组并发症比较差异无统计学意义（P〉0．05）。结论倒置LISS及Gamma钉均能有效治疗伴外侧壁骨折不稳定性股骨转子间骨折，倒置LISS可恢复外侧壁的完整性；两者术后髋关节功能恢复无差异。Gamma钉需避免术中外侧壁二次损伤；倒置LISS因偏心固定，术后不应强调过早负重。

Objective To compare clinical efficacy of inverse less invasive stabilization system （LISS） and Gamma nail in treating unstable femoral intertrochanteric fractures combined with lateral wail fractures. Methods Fifty-two patients with intertrochanteric fractures associated with lateral wall fractures followed up for at least 12 months after surgical treatment between June 2010 and June 2013 were included in this retrospective cohort study. According to the different internal fixation, the patients were assigned to inverse LISS group [ 16 males and 8 females; （62.5 ± 12.4） years] and Gamma nail group [ 17 males and 11 females; （60.4 ± 18.6）years ]. According to the AO classification, there were 6 patients with A2.2 type, 5 A2.3 type, 5 A3.1 type, 6 A3.2 type and 2 A3.3 type in inverse LISS group, and there were 4 patients with A2.2 type, 7 A2.3 type, 9 A3.1 type, 5 A3.2 type and 3 A3.3 type in Gamma nail group. Operation time, total blood loss （intraoperaive plus occult blood loss）, hospital length of stay, bone healing, time of commencing full weight-bearing and complication incidence were compared between the two groups. Harris hip score was recorded postoperatively. Results All patients were followed up for 24-36 months （ mean, 30.2 months）. Operation time in Gamma nail group was shorter than that in inverse LISS group （ P 〈 0.05 ）, while relatively more blood loss was found in Gamma nail group（ P 〈0.05 ）. There were no significant differences in hospital length of stay and bone healing timebetween the two groups （P 〉 0. 05 ）. Patients in Gamma nail groups started earlier full weight-bearing than inverse LISS group （P 〈0.05 ）. Harris score was （86. 1 ± 12.4）points in inverse LISS group one year after operation, not significantly different from （ 83.3 ±11. 2 ） points in Gamma nail group （ P 〉 0.05）. Complication of one patient with coxa vara and one bone nonunion in inverse LISS, showing no significant from one patient with screw breakage and one femoral head osteonecrosis in Gamma nail group （P 〉 0. 05 ）. Conclusions Both techniques are effective in treatment of intertroehanteric fractures combined with lateral wall fractures and achieve similar results in function recovery. But inverse LISS is eccentric fixation, so too early weight-bearing shouht not be over-emphasized.