三种髓内固定技术治疗老年股骨粗隆间骨折对患者股骨头旋转与固定钉滑脱的影响

Comparison of the screw sliding and femoral head rotation among gamma nail, PFNA and Inter Tan for elderly femoral intertrochanteric fractures

目的比较Gamma钉、PFNA和Inter Tan三种髓内固定技术治疗老年股骨粗隆间骨折对患者股骨头旋转与固定钉滑脱的影响。方法回顾性分析我科2011年6月至2015年6月期间采用上述三种髓内固定技术治疗的122例老年股骨粗隆间骨折患者的临床资料,其中31例采用3代Gamma钉固定技术,50例采用PFNA固定技术,41例采用Inter Tan固定技术。统计分析三组患者在放射学上的Evans-Jensen分型、术后4周固定钉滑脱量与股骨头旋转率。结果 Gamma钉、PFNA、Inter Tan三组患者术后4周的固定钉滑脱量分别为(4.40±1.21)mm、(4.35±1.43)mm、(4.18±1.36)mm,差异无统计学意义(P>0.05),而术后4周股骨头旋转率分别为22.6%(7/31)、8.0%(4/50)、2.4%(1/41),差异具有统计学意义(P<0.05)。结论对于老年股骨粗隆间骨折髓内钉固定术后患者,其股骨头旋转与固定钉滑脱量无关,而与近端固定钉的防旋特性(或设计特性)有关。Inter Tan可能更适合用于高Evans-Jensen分型的骨折患者。

Objective To compare the effect of gamma nail, PFNA and Inter Tan on screw sliding and femoral head rotation in elderly patients with femoral intertrochanteric fractures. Methods From June 2011 to June 2015, 122 patients aged over 60 years diagnosed as intertrochanteric fractures who were administered with intramedullary nail in our hospital were enrolled into the study, including 31 cases treated with gamma nail(GMA group), 50 cases with PFNA(PFNA group), and 41 cases with Inter Tan(Inter Tan group). The sliding length of the proximal screw and the ratio of femoral head rotation were evaluated by assessing radiographs 4 weeks after operation, and the results were compared among three groups. Results No significant differences was observed among the sliding lengths of GMA, PFNA, InterTan groups [(4.40±1.21) mm,(4.35±1.43) mm,(4.18±1.36) mm, P>0.05]. Femoral head rotation was observed in 7 cases in GMA group(22.6%, 7/31), 4 cases in PFNA group(8.0%, 4/50), and 1 case in Inter Tan group(2.4%, 1/41), and the differences were statistically significant(P<0.05). Conclusion For elderly patients with intertrochanteric fracture undergone intramedullary nail(Gamma nail, PFNA or Inter Tan), the femoral head rotation is not related to the degree of sliding, but is correlated to the rotational stability of the proximal screw. Inter Tan should be recommended for severe fracture types to avoid the likelihood of femoral head rotation leading to cut-out.