股骨近端抗旋髓内钉与第三代Gamma钉治疗股骨转子间骨折的效果对比

目的:探讨股骨近端抗旋转髓内钉与第三代Gamma钉治疗股骨转子间骨折的临床疗效,为骨科手术提供可借鉴的资料。方法:2009年4月-2013年3月期间在我院接受治疗的40例股骨转子间骨折患者,随机分为两组。其中,PFNA组20例患者采用股骨近端抗旋转髓内钉质量,而Gamma 3组20例患者采用第三代Gamma钉治疗。观察并比较两组患者的手术时间、影像增强剂时间和失血量,术后评价复位质量和内置物位置,在随访中,记录术后并发症,包括股骨干骨折、切出、再次手术、肺炎、尿路感染、脑梗塞、心肌梗塞和褥疮性溃疡等。另外,用Parker-Palmer活动评分系统评价行走能力。结果:PFNA和Gamma 3组在手术时间、影响增强剂时间和失血量上没有差异(P0.05);Gamma 3组病例复位质量要好于PFNA组,差异显著且具有统计学意义(P0.05);两组在内置物位置、行走能力和术后并发症上没有显著差异(P0.05)。结论:PFNA与Gamma 3治疗股骨转子间骨折具有很好的安全性和有效性,但Gamma3可获得更好的复位质量,应进一步在临床推广。

Comparative Analysis of the Clinical Effects between the Proximal FemoralNail Antirotation and the Gamma Nail on the Treatment of IntertrochantericFractures

Objective:Proximal femoral nail antirotation (PFNA) and third-generation Gamma nail (Gamma 3) are widely used inthe treatment of intertrochanteric fractures. However, it remains unclear which device achieves better clinical and radiographic outcomeswhen treating intertrochanteric fractures.Methods:40 patients with the intertrochanteric fractures who were treated by PFNA in ourhospital from April 2009 to March 2013 were selected as the PFNA group, and another 20 patients with either who were treated byGamma 3 were chosen to be the Gamma 3 group. Then the operative time, image intensifier time and amount of blood loss wererecorded. Following surgery, we assessed reduction quality and implant position. At the final follow-up, postoperative complications,including femoral shaft fracture, cutout, reoperation, pneumonia, urinary tract infection, cerebral infarction, cardiac infarction anddecubital ulcer, were recorded. In addition, walking ability was assessed by the Parker-Palmer mobility score.Results:No difference wasfound in the operative time, image intensifier time and amount of blood loss between patients treated with PFNA and those treated withGamma 3. The reduction quality of fractures treated with Gamma 3 was better than those treated with PFNA. However, there were nosignificant differences in implant position, walking ability and postoperative complications between the two groups. Although Gamma 3resulted in better reduction quality, it did not provide any advantages in walking ability and postoperative complications when comparedwith PFNA.Conclusion:Therefore, we conclude that both PFNA and Gamma 3 are safe and reliable devices for the treatment ofintertrochanteric fractures.