Gamma 3钉结合空心加压螺钉固定治疗外侧壁危险型股骨转子间骨折

Gamma 3 nails combined with hollow compression screw fixation for intertrochanteric fracture of risky external wall type

目的探讨Gamma 3钉结合空心加压螺钉固定治疗外侧壁危险型股骨转子间骨折的临床疗效。方法回顾性分析2015年11月至2017年12月期间武汉市第四医院骨科收治的60例外侧壁危险型股骨转子间骨折患者资料。根据治疗方式不同分为两组:A组27例,男15例,女12例;年龄为(57.5±16.2)岁;骨折AO分型:31-A2.2型14例,31-A2.3型13例;采用Gamma 3钉结合空心加压螺钉固定。B组33例,男18例,女15例;年龄为(59.3±15.1)岁;骨折AO分型:31-A2.2型17例,31-A2.3型16例;采用单独Gamma 3钉固定。比较两组患者的手术时间、术中出血量、住院时间、负重时间、骨折愈合时间、术后并发症发生率及末次随访时髋关节Harris评分等。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。60例患者术后获12~36个月(平均22.6个月)随访。A组与B组患者的手术时间、术中出血量、住院时间比较差异均无统计学意义(P>0.05)。A组患者术后外侧壁再移位的发生率[7.4%(2/27)]显著低于B组患者[24.2%(8/33)],术后负重时间[(5.4±1.0)周]及骨折愈合时间[(18.3±3.9)周]显著短于B组患者[(7.4±1.3)、(21.7±5.6)周],末次随访时髋关节Harris评分[(89.3±7.1)分]显著高于B组患者[(79.5±8.3)分],差异均有统计学意义(P<0.05)。随访期间两组无一例患者发生股骨头切割、内固定物断裂、下肢深静脉血栓形成、脂肪栓塞、髋内翻畸形及断钉等并发症。结论与单独Gamma 3钉固定比较,Gamma 3钉结合空心加压螺钉固定治疗外侧壁危险型股骨转子间骨折可以避免髓外固定及单纯髓内固定带来的外侧壁移位、内固定失效等,且不会增加手术时间和术中出血量,患者可以获得更好的功能恢复。

Objective To evaluate Gamma 3 nails combined with hollow compression screw fixation in the treatment of intertrochanteric fracture of risky external wall type.Methods From November 2015 to December 2017,60 patients with intertrochanteric fracture of risky external wall type were treated at Department of Orthopaedic Surgery,Wuhan Fourth Hospital.Of them,27 ones,15 males and 12 females with an age of 57.5 years±16.2 years(group A),were fixated with Gamma 3 nails and hollow compression screws,including 14 cases of AO type of 31-A2.2 and 13 cases of AO type of 31-A2.3.The other 33 patients,18 males and 15 females with an age of 59.3 years±15.1 years(group B),were fixated with Gamma 3 nails alone,including 17 cases of AO type of 31-A2.2 and 16 cases of AO type of 31-A2.3.The 2 groups were compared in terms of operation time,hospitalization time,intraoperative blood loss,weight-bearing time,fracture healing time,complications and Harris hip scores at the final follow-up.Results The 2 groups were comparable due to insignificant differences between them in preoperative general data(P>0.05).The 60 patients obtained an average follow-up of 22.6 months(from 12 to 36 months).There were no statistically significant differences in operation time,intraoperative blood loss or hospital stay between the 2 groups(P>0.05).Group A had a significantly lower incidence of external wall redisplacement[7.4%(2/27)],significantly shorter weight-bearing time(5.4 weeks±1.0 weeks)and fracture healing time(18.3 weeks±3.9 weeks),and significantly higher Harris hip scores at the final follow-up(89.3±7.1)than group B did[24.2%(8/33),7.4 weeks±1.3 weeks,21.7 weeks±5.6 weeks and 79.5±8.3,respectively](all P<0.05).Follow-ups revealed no complications like femoral head cutting,implant breakage,deep vein thrombosis of lower limb,fat embolism,hip varus deformity or nail breakage in either group.Conclusion In the treatment of intertrochanteric fracture of risky external wall type,compared with Gamma 3 nails alone,Gamma 3 nails combined with hollow compression screw fixation can avoid external wall displacement or fixation failure after external medullary fixation or intramedullary fixation alone but does not increase operation time or intraoperative blood loss,leading to better functional recovery.