第二代Gamma钉和InterTan治疗外侧壁不稳定型股骨转子间骨折疗效的前瞻性研究

Effects of second-generation Gamma nail and InterTan on the treatment of unstable intertrochanteric fractures of the lateral wall

目的探讨第二代Gamma钉和InterTan治疗外侧壁不稳定型股骨转子间骨折的疗效和对关节稳定性的影响。方法对2011年1月至2017年6月在我科行手术治疗的60例外侧壁不稳定型股骨转子间骨折患者,按随机数字表法分为观察组(第二代Gamma钉组)和对照组(InterTan组),每组30例,比较两组手术时间、术中出血量和骨折愈合时间。所有患者均获平均(11～16)(13.3±2.5)个月随访。术后1周、3个月和末次随访行X线片检查,测量Garden指数和尖顶距(tip-apex distance,TAD),并行髋关节功能Sander评分,同时记录不良反应发生率。结果两组手术时间、术中出血量、骨折愈合时间差异无统计学意义(P=0.683,0.575,0.582)。术前和术后1周两组Garden指数差异无统计学意义(P=0.083,0.078);术后3个月和1年观察组正侧位Garden指数高于对照组,组间差异有统计学意义(P均=0.001),观察组TAD小于对照组,组间差异有统计学意义(P均=0.001)。术后1周和3个月两组TAD差异无统计学意义(P=0.078,0.061)。术前两组Sander评分差异无统计学意义(P=0.093),术后1周、3个月和1年观察组Sander评分高于对照组,组间差异有统计学意义(P=0.001,0.001,0.000)。观察组术后1例泌尿系感染,1例下肢深静脉血栓形成,经治疗后均获得痊愈。观察组头钉切出1例,对照组头钉切出4例,1例股骨干骨折,2例髋内翻。结论与Gammar钉相比,InterTan在外侧壁不稳定型股骨转子间骨折的治疗中固定稳定性更好,并发症发生率低,值得临床推广。

Objective To investigate the effects of second-generation Gamma nail and InterTan on the treatment of unstable intertrochanteric fractures of the lateral wall and its effects on joint stability.Methods From January 2011 to June 2017,60 patients with unstable lateral femoral intertrochanteric fractures,who underwent surgery in our department,were randomly divided into the observation group(InterTan group,n=30)and control group(second-generation Gamma nail group,n=30).Operation time,intraoperative blood loss and fracture healing time were compared between the 2 groups.The mean follow-up was(13.3±2.5)months(range:11-16 months).X-ray examination was performed at 1 week,3 months,and the last follow-up.The Garden index and apex distance were measured,and the Sander function of the hip was recorded.The incidence of adverse reactions was also recorded.Results There were no significant differences in operation time,intraoperative blood loss and fracture healing time between the 2 groups(P=0.683,0.575,0.582).There were no significant differences in Garden index between the 2 groups before and 1 week after operation(P=0.083,0.078).The Gardener index of the positive side of the observation group was higher than that of the control group at 3 months and 1 year after operation.The differences between the 2 groups were statistically significant(P=0.001).There were no significant differences in TAD between the 2 groups at 1 week and 3 months after operation(P=0.001).The TAD of the observation group was lower than that of the control group at 3 months and 1 year after operation,and the differences between the 2 groups were statistically significant(P=0.078,0.061).There were no significant differences between the 2 groups(P=0.093).The Sander scores of the observation group were higher than those of the control group at 1 week,3 months and 1 year after operation.The differences between the 2 groups were statistically significant(P=0.001,0.001,0.000).One patient had urinary tract infection and one patient had deep vein thrombosis of the lower extremity after operation.All of them recovered after treatment.In the observation group,a head nail was cut out,while 4 in the control group.One case had a femoral shaft fracture,and 2 cases had hip varus.Conclusions InterTan is stable in the treatment of unstable intertrochanteric fractures of the lateral wall.The incidence of complication is low,which is worthy of clinical promotion.