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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2017, Vol. 11 ›› Issue (16) : 2115 -2119. doi: 10.3877/cma.j.issn.1674-0785.2017.16.002

所属专题： 骨科学； 文献；

临床论著

锁定型Gamma钉与改良Gamma钉治疗高龄不稳定型股骨粗隆间骨折的效果比较
张磊1,†(), 沈杰2, 黄宰宇1, 刘丹1, 何帅3, 应志豪1, 吴震东1   
  1. 1. 325000　温州，解放军第118医院骨科
    2. 400038　重庆，第三军医大学西南医院骨科
    3. 325000　温州，解放军第118医院口腔科
  • 收稿日期:2017-02-22 出版日期:2017-08-15
  • 通信作者: 张磊
  • 基金资助:
    温州市科技计划项目(Y20100220)

Clinical effects of locking gamma nail versus modified gamma nail for treatment of unstable intertrochanteric femoral fractures in elderly patients

Lei Zhang1,†(), Jie Shen2, Zaiyu Huang1, Dan Liu1, Shuai He3, Zhihao Ying1, Zhendong Wu1   

  1. 1. Department of Orthopaedics, the 118th Hospital of PLA, Wenzhou 325000, China
    2. Center of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
    3. Department of Stomatology, the 118th Hospital of PLA, Wenzhou 325000, China
  • Received:2017-02-22 Published:2017-08-15
  • Corresponding author: Lei Zhang
  • About author:
    Corresponding author: Zhang Lei, Email:
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张磊, 沈杰, 黄宰宇, 刘丹, 何帅, 应志豪, 吴震东. 锁定型Gamma钉与改良Gamma钉治疗高龄不稳定型股骨粗隆间骨折的效果比较[J/OL]. 中华临床医师杂志(电子版), 2017, 11(16): 2115-2119.

Lei Zhang, Jie Shen, Zaiyu Huang, Dan Liu, Shuai He, Zhihao Ying, Zhendong Wu. Clinical effects of locking gamma nail versus modified gamma nail for treatment of unstable intertrochanteric femoral fractures in elderly patients[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2017, 11(16): 2115-2119.

目的

比较锁定型Gamma钉（LGN）与改良Gamma钉（MGN）治疗高龄股骨粗隆间不稳定型骨折的临床效果。

方法

回顾性分析解放军第118医院2008年1月至2012年5月143例接受LGN或MGN内固定治疗的高龄股骨粗隆间不稳定型骨折患者的临床资料。其中LGN组67例，MGN组76例，均为不稳定型骨折，对比分析两种手术方法在骨折愈合时间、Harris髋关节功能评分、骨折端压缩程度、颈干角角度变化等方面的差异，其中计量资料采用组间t检验（骨折愈合时间、Harris髋关节功能评分、骨折端压缩程度），计数资料（颈干角角度变化）采用χ2检验。

结果

患者均获得随访，与MGN组比较，LGN组骨折愈合时间较长[（16.8±7.4）周vs （14.4±6.6）周，P<0.05]，但髋关节功能恢复更佳[（86.6±6.3）分vs （83.1±6.7）分，P<0.05]，且颈干角角度变化≥10°比例更小（3.0% vs 14.5%，P<0.05），骨折端压缩程度更少[（4.4±2.5）mm vs （7.3±3.1） mm，P<0.05]。

结论

LGN和MGN均为治疗高龄股骨粗隆间不稳定型骨折的有效方法，但LGN在防止骨折压缩、塌陷及髋关节功能恢复等方面更具优势。

关键词: 股骨粗隆间骨折, 不稳定型, 高龄, 锁定型Gamma钉, 内固定
Objective

To compare the clinical effects of locking gamma nail (LGN) with modified gamma nail (MGN) in the management of unstable intertrochanteric femoral fractures in elderly patients.

Methods

A total of 143 elderly patients with unstable intertrochanteric femoral fractures who were treated with LGN (n = 67) or MGN (n = 76) at the 118th Hospital of PLA from January 2008 to May 2012 and had complete clinical data were retrospectively studied. We compare the two groups in terms of fracture healing time, Harris hip score, degree of fracture compression, and variation of Neck shaft angle. Continuous variables (fracture healing time, Harris hip score, and the degree of fracture compression) were compared using the paired t-test, and comparison of categorical variables (the change of Neck shaft angle) was performed using the chi-squared test.

Results

All of the patients were followed successfully. Compared with the MGN group, the LGN group had significantly longer fracture healing time [(16.8 ± 7.4) weeks vs (14.4 ± 6.6) weeks], less variation of neck-shaft angle (3.0% vs 14.5%), lower degree of fracture compression [(4.4 ± 2.5) mm vs (7.3 ± 3.1) mm], and higher Harris hip score [(86.6 ± 6.3) scores vs (83.1 ± 6.7) scores] (P < 0.05 for all).

Conclusion

Both LGN and MGN are effective in the management of unstable intertrochanteric femoral fractures in elderly patients, but LGN has more advantages in preventing compression of fracture end and recovery of hip joint function compared to MGN.

Key words: Intertrochanteric femoral fractures, Unstable, Elderly patients, Locking gamma nail, Internal fixation
图1 两种内置物实物对比图　a.锁定型Gamma钉；b.改良Gamma钉
表1 患者术前一般情况及术后骨折复位质量评估（例）
组别 例数 年龄（岁，±s） 性别 AO分型 术前ASA分级 骨折复位质量
男 女 A2 A3 Ⅰ Ⅱ Ⅲ Ⅳ 良好 可 差
LGN组 67 80.5±7.3 27 40 50 17 13 38 16 0 58 7 2
MGN组 76 80.0±6.9 30 46 57 19 15 42 19 0 65 8 3
统计值 ? t=0.402 χ2=0.010 χ2=0.003 χ2=0.034 χ2=0.099
P值 ? 0.689 0.920 0.959 0.983 0.952
表2 2组患者术后随访情况（±s）
组别 例数 随访时间（个月） 骨折愈合（周） 末次Harris评分（分） 颈干角改变≥10°[例（%）] 骨折压缩（mm）
LGN组 67 23.0±6.4 16.8±7.4 86.6±6.3 2（3.0） 4.4±2.5
MGN组 76 23.2±5.8 14.4±6.6 83.1±6.7 11（14.5） 7.3±3.1
统计值 ? t=-0.299 t=2.046 t=3.253 χ2=4.382 t=-6.161
P值 ? 0.766 0.043 0.001 0.036 0.000
图2 两种内置物术后2年颈干角变化效果对比　2a.改良Gamma钉组患者A术后当天右髋部正位X线片示骨折复位可，颈部螺钉位置偏近端，颈干角120°；2b.改良Gamma钉组患者A术后2年右髋部正位X线片示颈干角105°，颈部螺钉出现切割、退钉，骨折端出现明显压缩塌陷，髋内翻畸形；2c.锁定型Gamma钉组患者B术后当天右髋部正位X线片示骨折复位及螺钉位置良好，颈干角131°；2d.锁定型Gamma钉组患者B术后2年右髋部正位X线片示颈干角131°，骨折端无明显压缩
[1]
Carpintero P, Caeiro JR, Carpintero R, et al. Complications of hip fractures: A review [J]. World J Orthop, 2014, 5(4): 402-411.
[2]
Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults [J]. Cochrane Database Syst Rev, 2010, 8(9): CD000093.
[3]
张磊, 刘丹, 吴震东, 等. 锁定型GAMMA钉治疗不稳定性股骨粗隆间骨折的生物力学分析 [J]. 中国矫形外科杂志, 2010, 18(12): 1028-1029.
[4]
Zhang L, Shen J, Chen SX, et al. Treatment of unstable intertrochanteric femoral fractures with locking gamma nail(LGN): A retrospective cohort study [J]. Int J Surg, 2016, 26(5): 12-17.
[5]
Magi E. ASA classification and perioperative variables as predictors of postoperative outcome [J]. Br J Anaesth, 1997, 78(2): 228.
[6]
Reuling EM, Sierevelt IN, van den Bekerom MP, et al. Predictors of functional outcome following femoral neck fractures treated with an arthroplasty: limitations of the Harris hip score [J]. Arch Orthop Trauma Surg, 2012, 132(2): 249-256.
[7]
Hassankhani EG, Omidi-Kashani F, Hajitaghi H, et al. How to treat the complex unstable intertrochanteric fractures in elderly patients? DHS or arthroplasty [J]. Arch Bone Joint Surg, 2014, 2(3): 174.
[8]
Kleweno C, Morgan J, Redshaw J, et al. Short versus long cephalomedullary nails for the treatment of intertrochanteric hip fractures in patients older than 65 years [J]. J Orthop Trauma, 2014, 28(7): 391-397.
[9]
Gotfried Y. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation [J]. J Bone Joint Surg Am, 2007, 89(11): 2552-2553.
[10]
Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies [J]. J Bone Joint Surg Am, 2004, 86(2): 398-410.
[11]
Saarenpaa I, Heikkinen T, Ristiniemi J, et al. Functional comparison of the dynamic hip screw and the Gamma locking nail in trochanteric hip fractures: a matched-pair study of 268 patients [J]. Int Orthop, 2009, 33(1): 255-260.
[12]
Bojan AJ, Beimel C, Taglang G, et al. Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures [J]. BMC Musculoskel Dis, 2013, 14(1): 1.
[13]
Vidyadhara S, Rao SK. Cephalomedullary nails in the management of ipsilateral neck and shaft fractures of the femur-One or two femoral neck screws? [J]. Injury, 2009, 40(3): 296-303.
[14]
Ma J, Xing D, Ma X, et al. The percutaneous compression plate versus the dynamic hip screw for treatment of intertrochanteric hip fractures: a systematic review and meta-analysis of comparative studies [J]. Orthop Traumatol Surg Res, 2012, 98(7): 773-783.
[15]
Kuzyk PR, Shah S, Zdero R, et al. A biomechanical comparison of static versus dynamic lag screw modes for cephalomedullary nails used to fix unstable peritrochanteric fractures [J]. J Trauma Acute Care Surg, 2012, 72(2): E65-E70.
[16]
Dujardin F, Benez C, Polle G, et al. Prospective randomized comparison between a dynamic hip screw and a mini-invasive static nail in fractures of the trochanteric area: preliminary results [J]. J Orthopaed Trauma, 2001, 15(6): 401-406.
[17]
Zhu Y, Meili S, Zhang C, et al. Is the lag screw sliding effective in the intramedullary nailing in A1 and A2 AO-OTA intertrochanteric fractures? A prospective study of Sliding and None-sliding lag screw in Gamma-Ⅲ nail [J]. Scand J Trauma Resusc Emerg Med, 2012, 20(1): 1-8.
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