Gamma3长钉与InterTan内固定治疗老年Seinsheimer Ⅴ型股骨粗隆下骨折的疗效比较研究

Comparative study of Gamma3 long nail and Inter Tan internal fixation for the treatment of elderly Seinsheimer Ⅴ-type femoral subtrochanteric fracture

目的比较第3代Gamma长钉与Inter Tan内固定治疗老年Seinsheimer Ⅴ型股骨粗隆下骨折的疗效。方法回顾性分析2016年1月-2018年3月南通大学附属海安医院骨科收治Seinsheimer Ⅴ型股骨粗隆下骨折患者48例,男性28例,女性20例;年龄62~78岁,平均68.7岁;摔伤40例,道路交通伤8例。根据内固定方式不同分为Gamma组(23例)和Inter Tan组(25例)。比较两组患者手术时间、显性出血量、隐性失血量(HBL)、总失血量(TBL)、骨折愈合时间和Harris髋关节功能评分(HHS),以及术后并发症情况。结果术后随访时间为14~29个月,平均22.3个月。两组骨折愈合时间、末次随访HHS评分比较[(7.8±4.3)个月vs.(8.0±3.8)个月、(83.9±7.8)分vs.(82.3±6.7)分],差异无统计学意义(P=0.355,0.268)。两组患者手术时间、显性出血量、HBL及TBL比较[(57.2±36.7) min vs.(90.5±34.1) min、(140.3±26.4) m L vs.(255.1±36.0) m L、(469.6±197.4) m L vs.(656.2±208.1) m L、(606.0±209.5) m L vs.(902.6±255.8) m L],差异均有统计学意义(P=0.014,<0.001,<0.001,<0.001)。Gamma组术后并发症(伤口感染、内固定失效、髋内翻)发生率8.7%,Inter Tan组12.0%,差异无统计学意义(P=0.862)。结论 Gamma3长钉和Inter Tan均是治疗老年Seinsheimer Ⅴ型股骨粗隆下骨折的有效方法,但Gamma3长钉与Inter Tan相比手术时间更短,出血量更少。

Objective To compare the efficacy of third-generation Gamma long nail and Inter Tan internal fixation for the treatment of elderly Seinsheimer Ⅴ-type femoral subtrochanteric fractures. Methods A retrospective analysis of 48 patients who underwent surgical treatment for Seinsheimer Ⅴ-type femoral trochanteric fractures in the Department of Orthopaedics,Nantong University from Jan. 2016 to Mar. 2018 was carried out. Among them 28 were male and 20 were female,aged 62-78 years,with an average of 68. 7 years. Forty patients were injured by accidental falls,and 8 were injured in traffic accident. According to the internal fixation method,they were divided into Gamma group( n = 23) and Inter Tan group( n = 25). The surgical time,gross blood loss,hidden blood loss( HBL),total blood loss( TBL),fracture healing time,and Harris hip score( HHS) were compared between the two groups of patients. Postoperative complications were recorded and compared. Patients are followed up through outpatient clinics after surgery for at least 12 months. Results The follow-up time was 14 to 29 months,and the average follow-up time was 22. 3 months. There was no statistically significant difference in fracture healing time and HHS score between the Gamma group and the Inter Tan group at the last follow-up [( 7. 8 ± 4. 3) vs.( 8. 0 ± 3. 8) months,( 83. 9± 7. 8) vs.( 82. 3 ± 6. 7) points,P = 0. 355,0. 268]. Comparison of surgical time,visible blood loss,HBL and TBL between Gamma group and Inter Tan group [( 57. 2 ± 36. 7) vs.( 90. 5 ± 34. 1) min,( 140. 3 ± 26. 4) vs.( 255. 1 ±36. 0) m L,( 469. 6 ± 197. 4) vs.( 656. 2 ± 208. 1) m L,( 606. 0 ± 209. 5) vs.( 902. 6 ± 255. 8) m L]showed statistical differences( P = 0. 014,< 0. 001,< 0. 001,< 0. 001). The incidence of postoperative complications( wound infection,internal fixation failure and hip varus deformity) was 8. 7% in the Gamma group and 12. 0%in the Inter Tan group,and the difference was not statistically significant( P = 0. 862). Conclusion Gamma3 nails and Inter Tan are effective methods for the treatment of elderly Seinsheimer Ⅴ-type femoral subtrochanteric fractures,but Gamma3 nails has shorter operative time and less bleeding compared with Inter Tan.