Gamma钉与DHS治疗股骨粗隆间骨折继发股骨干骨折的系统评价

目的运用Cochrane系统评价的方法,对不同设计的Gamma钉进行亚组分析,比较Gamma钉与动力髋螺钉治疗股骨粗隆间骨折继发股骨干骨折的发生率。方法纳入比较Gamma钉与动力髋螺钉内固定治疗成人股骨粗隆间骨折的随机和半随机对照试验,由两名评价员独立评价文献质量并提取术中及术后股骨干骨折的患者人数,采用随机效应模型进行Meta分析,对评价指标计算相对危险度(relative risk,RR)及其95%置信区间(confidence interval,CI),将纳入文献分为2000年之前研究组和2000年之后研究组,进行亚组分析。结果共纳入14个研究,其中13个研究提供了发生术中股骨干骨折的患者资料,Meta分析结果提示Gamma钉固定治疗股骨粗隆间骨折明显增加了术中股骨干骨折的发生率(RR=2.72,95%CI,1.17~6.31,P=0.02)。2000年之前亚组包括8个研究,Meta分析结果提示,Gamma钉固定治疗股骨粗隆间骨折术中发生股骨干骨折的危险是动力髋内固定的3倍(RR=3.00,95%CI,1.02~8.85,P=0.05)。2000年之后亚组包括5个研究,Meta分析结果提示,与动力髋内固定相比,Gamma钉固定没有增加发生术中股骨干骨折的风险,两者之间差异无统计学意义(RR=2.33,95%CI,0.61~8.92,P=0.22)。13个研究提供了发生术后股骨干骨折的患者资料,Meta分析结果提示,与动力髋内固定相比,Gamma钉固定治疗股骨粗隆间骨折明显增加了术后股骨干骨折的发生率(RR=3.62,95%CI,1.31~10.02,P=0.01)。2000年之前亚组的8个研究Meta分析结果提示,Gamma钉固定治疗股骨粗隆间骨折术后发生股骨干骨折的危险是动力髋内固定的4倍,两者有统计学差异(RR=4.03,95%CI,1.20~13.54,P=0.02)。2000年之后亚组包括5个研究,Meta分析结果提示,Gamma钉固定与动力髋固定相比,两者术后股骨干骨折发生率差异无统计学意义(RR=2.80,95%CI,0.43~18.23,P=0.28)。结论随着Gamma钉设计改进及Gamma钉置入技术经验的丰富,Gamma钉固定股骨粗隆间骨折继发股骨干骨折的风险逐渐降低,因此,对先前的随机对照试验及Meta分析的结论需要保持谨慎。     

Gamma 3型髓内钉与DHS、股骨近端锁定钢板内固定治疗老年股骨粗隆间骨折的疗效比较

目的比较Gamma 3型髓内钉内固定与动力髋螺钉(DHS)、股骨近端锁定钢板内固定治疗老年股骨粗隆间骨折的临床疗效。方法选取自2011-04—2013-06行手术治疗的120例股骨粗隆间骨折作为研究对象,根据手术方式的不同分为3组。采用Gamma 3型髓内钉内固定治疗40例(Gamma钉组),采用DHS内固定治疗40例(DHS组),采用股骨近端锁定钢板内固定40例(锁定钢板组)。观察3组手术时间、术中失血量、术后并发症、骨折愈合时间以及术后6个月髋关节功能恢复情况。结果 Gamma钉组手术时间明显短于DHS组(t=6.861,P0.001)和锁定钢板组(t=23.330,P0.001),术中失血量明显少于DHS组(t=8.359,P0.001)和锁定钢板组(t=14.854,P0.001),差异有统计学意义(P0.05)。Gamma钉组并发症发生率为7.5%,DHS组并发症发生率为25.0%,锁定钢板组并发症发生率为20.0%,Gamma组并发症发生率明显低于DHS组(χ2=4.501,P=0.032)和锁定钢板组(χ2=2.988,P=0.040),差异有统计学意义(P0.05)。3组骨折愈合时间差异无统计学意义(F=1.867,P=0.598)。3组术后6个月髋关节功能评分差异无统计学意义(F=1.305,P=0.772)。结论 Gamma 3型髓内钉与DHS、股骨近端锁定钢板内固定治疗老年股骨粗隆间骨折在骨折愈合时间和髋关节功能恢复情况方面并无明显差异,但是Gamma 3型髓内钉内固定术后早期并发症较少,效果优于其他2种术式。     

比较PFNA钉与Gamma钉治疗股骨干骨折合并同侧股骨近端骨折的效果

目的对比PFNA钉(防旋髓内钉)与Gamma(伽马)钉治疗股骨干骨折合并同侧股骨近端骨折的效果。方法选取2015-01—2016-06间收治的92例股骨干骨折并同侧近端骨折患者,按照治疗方式的不同分为2组,每组46例。对照组给予加长GammaⅡ固定,观察组予以加长PFNA钉固定。观察2组治疗效果。结果观察组术中出血量及手术时间均少于对照组,Harris各项评分均较高于对照组,差异有统计学意义(P0.05)。2组骨折愈合时间差异无统计学意义(P0.05)。结论股骨干合并同侧股骨近端骨折采取PFNA钉治疗,能有效缓解疼痛,减少术中出血量及手术时间,并利于髋关节功能恢复。     

股骨近端防旋髓内钉和Gamma钉治疗老年不稳定型股骨转子间骨折疗效比较

目的比较股骨近端髓内钉和Gamma钉治疗老年不稳定股骨转子间骨折的疗效。方法将133例老年不稳定股骨转子间骨折患者按内固定方法分为股骨近端髓内钉(PFNA)组55例和Gamma钉组78例。比较两组的手术技巧、术后并发症、骨折愈合情况和髋关节功能。结果两组患者均获随访,时间6~18个月。两组在手术时间、术中出血量、骨折愈合情况及髋关节功能(末次随访Harris评分)比较差异均无统计学意义(P0.05)。Gamma钉组出现2例髋螺钉切割,1例远端锁钉断裂,1例股骨干骨折;PFNA组无相关并发症发生。结论 PFNA和Gamma钉均是治疗老年不稳定型股骨转子间骨折的理想方法。与Gamma钉相比,PFNA显著降低了术后并发症,更适用于治疗老年骨质疏松性不稳定型股骨转子间骨折。     

动力髋与Gamma钉治疗成人股骨粗隆间骨折疗效的Meta分析

目的 对动力髋与Gammai钉两种内固定物治疗成人股骨粗隆间骨折的疗效进行Meta评价.方法 计算机检索MEDLINE、EMBASE、Cochrane图书馆、Cochrane协作网肌骨创伤组试验数据库和中国生物医学文献数据库,收集所有相关随机对照试验及半随机对照试验,且采用RevMan 4.2.10进行Meta分析.结果 共纳入8个随机对照试验,1个半随机对照试验.Meta分析显示,Gamma钉组术中和术后股骨干骨折的发生率明显增加,二次手术率较高.结论 与动力髋组治疗股骨粗隆间骨折相比,Gamma钉组术中和术后股骨干骨折的发生率明显增加,二次手术率更高.但两种内固定器械与拉力螺钉切割出股骨头、术区深部感染、血栓栓塞发生率等的关系尚需更多设计严格的大样本随机对照试验进一步研究.     

Gamma钉与DHS钉治疗股骨粗隆间骨折的临床对照研究

目的 比较Gamma钉与DHS钉治疗股骨粗隆间骨折的临床疗效. 方法 选择2008年1月至2012年5月收治的100例股骨粗隆间骨折患者,将其随机分为两组,在闭合复位的基础上,分别予以Gamma钉与DHS钉固定,观察并比较两组患者手术期各项指标、术后并发症以及术后髋关节功能情况. 结果 Gamma钉组的术中失血量及术后并发症的发生率明显低于DHS组,而Kuderna髋关节功能评分优良率要高于DHS组,差异有统计学意义(均P＜0.05). 结论 Gamma钉在治疗上较DHS具有操作简单、手术损伤小、骨折固定牢固、疗效可靠、并发症少等优点,适于临床推广.     

Gamma钉治疗股骨粗隆间骨折的研究进展

粗隆间骨折是老年人常见的一种骨折,如何治疗使之尽快恢复下肢功能、减少长期卧床并发症、避免2次手术非常重要。目前老年粗隆间骨折常用的经典治疗方法是动力髋螺钉(DHS)、滑动髋螺钉(SHS)、加压髋螺钉(CHS)等,由于是偏心性固定,对不稳定的粗隆下骨折固定稍差,髓内系统生物力学较好,包括髋部髓内钉(intramedullaryhipscrew ,IMHS)、Gamma钉和股骨近端钉(PFN)等。1　Gamma钉的生物力学Gamma钉力矩较短,抗弯应力强[1] ,髓内钉比DHS可减少约2 5 %～3 0 %的弯曲应力,减少内固定物折断[2 ] 。骨折不稳定时Gamma钉对股骨距的加压应力增…     

股骨近端髓内钉治疗老年股骨转子间不稳定骨折

股骨转子间骨折是老年人常见的骨折，原则上应早期手术治疗。目前普遍使用的内固定系统有动力髋螺钉（DHS）、Gamma钉及股骨近端髓内钉（PFN）等。本院自2003年4月至2006年4月．采用PFN治疗老年股骨转子间不稳定骨折38例，疗效满意。现总结报告如下。     

Gamma 3型髓内钉和动力髋螺钉内固定治疗高龄股骨粗隆间骨折的临床研究

目的探讨Gamma 3型髓内钉(Gamma 3钉)和动力髋螺钉(DHS)内固定治疗高龄股骨粗隆间骨折的临床效果。方法对82例高龄(年龄大于75岁)股骨粗隆间骨折采用手术治疗,其中44例采用Gamma 3钉内固定(Gamma 3钉组),38例采用DHS内固定(DHS组)。比较两组手术时间、术中出血量、术前和术后1周肌酸激酶、术后髋关节Harris评分。结果 Gamma 3钉组平均手术时间、术中出血量、术后7 d血清肌酸激酶含量较DHS组低,差异有统计学意义(P<0.05)。Gamma 3钉组术后1周、6个月Harris评分较DHS组高,但术后12个月两组差异无统计学意义(P>0.05)。结论Gamma 3钉较DHS在内固定治疗高龄股骨粗隆间骨折时具有手术时间短、出血少、创伤小、术后短期恢复快的优点。两种内固定术后都能够获得良好的骨折愈合和远期临床治疗效果。     

股骨粗隆间骨折Gamma钉和DHS内固定治疗比较

目的比较Gamma钉和DHS治疗股骨粗隆间骨折的疗效及其应用选择。方法73例股骨粗隆间骨折分别接受DHS和Gamma钉内固定治疗,从临床愈合时间、术后功能恢复程度及术后并发症等方面进行比较。结果经术后8～21个月随访,Gamma钉功能优良率95.1%,DHS优良率84.4%,两组差异有统计学意义(P<0.05),Gamma钉组骨折临床愈合时间缩短,手术创伤较小,DHS组术后并发症较高。结论对ⅠA型无移位和ⅠB型部分移位的股骨粗隆间骨折,DHS和Gamma钉两种内固定均可;对Ⅱ、Ⅲ型骨折,适用Gamma钉。     

Gamma钉和动力髋螺钉内固定治疗股骨转子间骨折临床疗效比较

目的比较Gamma钉和动力髋螺钉治疗股骨转子间骨折的疗效。方法将100例股骨转子间骨折患者随机分为2组(各50例),分别进行Gamma钉以及DHS治疗,对两组患者住院时间、下床时间以及骨折愈合时间、并发症进行比较。结果住院时间、下床时间、骨折愈合时间:Gamma钉组分别为(12.4±2.3)d、(63.8±4.9)d、(9.8±1.3)d;DHS组分别为(15.6±1.4)d、(84.7±3.9)d、(13.2±2.9)d;两组三方面比较差异均有统计学意义(P<0.05)。按Sahin et al法评定疗效:Gamma钉组优35例,良12例,差3例,优良率94%;DHS组优13例,良27例,差10例,优良率80%;两组比较差异有统计学意义(P<0.05)。并发症比较:Gamma钉组切口感染2例,股骨骨折4例,髋内翻2例,发生率16%;DHS组切口感染3例,股骨骨折3例,髋内翻8例,发生率28%;Gamma钉组髋内翻发生率低于DHS组(P<0.05)。结论 Gamma钉治疗股骨转子间骨折的疗效明显优越于DHS治疗。     

不同固定方法治疗老年股骨转子间骨折疗效比较

目的评价动力髋螺钉（DHS）、Gamma钉和防旋股骨近端髓内钉（PFNA）治疗老年不稳定股骨转子间骨折的临床疗效。方法对162例股骨转子间骨折患者分别采用DHS、Gamma钉及PFNA治疗。比较3种方式的手术时间、术中术后出血量、手术并发症及术后疗效。结果 162例均获随访,时间1~2年。手术时间及术中出血量3组比较差异有统计学意义（P〈0.05）。术后3 d引流量：PFNA组与DHS组比较差异有统计学意义（P〈0.05）。术后18个月内并发症总发生率比较DHS组最高（P〈0.05）;术后疗效比较3组差异无统计学意义（P〉0.05）。结论与DHS、Gamma钉比较,PFNA手术时间短、出血量少、术后并发症发生率低,在治疗老年不稳定股骨转子间骨折应用中占有优势。     

A randomized study of the compression hip screw and Gamma nail in 426 fractures

A prospective, randomized study comparing the compression hip screw with the Gamma nail in the treatment of 426 intertrochanteric fractures is reported. The median patient age was 80 years, and 71% were women The compression hip screw operation took less time except in Evans Type 5 fractures. Blood loss generally was less in the compression hip screw group except in patients with Type 5 fractures. The most frequent surgical problem for patients in the Gamma group was problems with distal locking. Cephalic position of the femoral head screw and cut-out were seen more often in the Gamma nail group. The Gamma nail more frequently preserved the fracture position obtained perioperatively. Whether there was distal locking of the Gamma nail in unstable fractures did not seem to affect the healing rate. Additional fissures or fractures in the proximal femur occurred during five Gamma nail operations and two compression hip screw operations. Postoperative walking ability did not differ between the groups. At 6 months 88% of the fractures were healed. In less comminuted fractures, the compression hip screw method is the preferred method of treatment whereas the Gamma nail is an alternative treatment for more comminuted Evans Type 5 fractures.     

A meta-analysis of the Gamma nail and dynamic hip screw in treating peritrochanteric fractures

The objective of this meta-analysis was to compare the fixation outcome of the Gamma nail and dynamic hip screw (DHS) in treating peritrochanteric fractures. Relevant randomised controlled studies were included, and the search strategy followed the requirements of the Cochrane Library Handbook. Methodological quality was assessed and data were extracted independently. Seven studies involving 1,257 fractures were included which compared the effect of the Gamma nail and DHS. The results showed a higher rate of postoperative femoral shaft fracture with the Gamma nail compared to the DHS [relative risk (RR): 7.27, 95% confidence interval (CI): 2.83–18.70, P < 0.0001] but no statistical differences in wound infection (RR: 1.02, 95% CI: 0.56–1.86), mortality (RR: 1.00, 95% CI: 0.81–1.24), re-operation (RR: 1.64, 95% CI: 0.91–2.95) and walking independently after rehabilitation (RR: 0.89, 95% CI: 0.60–1.33). It seemed that there were no obvious advantages of the Gamma nail over the DHS in treating peritrochanteric fractures.     

DHS与PFNA治疗老年股骨粗隆间骨折的比较

目的比较动力加压髋螺钉（dynamic hip screw,DHS）和抗旋股骨近端髓内钉（proximal femoral nail antirotation,PFNA）对老年股骨粗隆间骨折治疗的手术效果。方法把年龄6l一81岁的72例股骨粗隆间骨折患者随机分为：DHS手术组（对照组）36例和PFNA手术组（实验组）36例。术后就这两种手术的疗效进行评价。结果两组创口大小、术中出血量、术后引流量、平均手术时间及愈合时间等多项指标比较,差异均有显著统计学意义（P〈0．01或P〈0．05）,实验组疗效显著。两组在延迟愈合、肺部感染、泌尿系感染等并发症比较,差异均有显著统计学意义（P〈0．01或P〈0．05）,PFNA治疗组术中术后并发症显著减少。两组患者疗效比较,治疗组评分明显高于对照组,即PFNA组手术疗效明显优于DHS组。结论PFNA是治疗老年股骨粗隆间骨折较理想的内固定物。     

老年人股骨粗隆间骨折126例手术治疗分析

目的评价四种手术方法治疗老年人股骨粗隆间骨折的疗效。方法回顾性分析我院于2004年9月至2007年12月收治的老年人股骨粗隆间骨折患者126例,其中应用空心加压螺钉治疗25例,动力髋螺钉治疗41例,股骨近端髓内钉治疗24例,人工股骨头置换术治疗36例。结果112例获得随访,时间6个月～3年,平均23．5个月,四种手术方法疗效均满意。结论治疗老年人股骨粗隆间骨折,四种手术方法各有优势,只有根据患者年龄、骨折类型、骨质疏松程度、手术耐受情况等合理选择手术方式,方可取得良好疗效。     

Trochanteric gamma nail and compression hip screw for trochanteric fractures: a randomized, prospective, comparative study in 210 elderly patients with a new design of the gamma nail

OBJECTIVES: To compare the results between a new intramedullary Gamma nail and a compression hip screw in the treatment of trochanteric fractures. DESIGN: Prospective randomized. SETTING: Level 1 trauma center. PATIENTS: Two hundred ten consecutive patients older than 65 years with trochanteric femoral fractures. INTERVENTIONS: Treatment with a compression hip screw or a new design of the Trochanteric Gamma nail (180 mm in length with a mediolateral angle of 4 degrees and available only with a proximal diameter of 17 mm and distal diameter of 11 mm). MAIN OUTCOME MEASUREMENTS: Operative and fluoroscopy times, blood loss, functional outcome, complication rate, and failure of fixation. RESULTS: The Trochanteric Gamma nail was used in 104 patients and the compression hip screw in 106. The 2 groups were similar in terms of their preoperative data, with a median follow-up of 13.6 months (range 12-30). The results show no difference in operating time (P = 0.21), but the Trochanteric Gamma nail group had a significantly shorter fluoroscopy time (P = 0.006), and the number of patients transfused and the mean of units of blood transfused were significantly less in the Trochanteric Gamma nail group (P = 0.013, 0.046, respectively). Mortality within 12 months was similar in both groups (P = 0.83). All fractures were radiographically healed at the last visit. There was no difference in intraoperative and postoperative complications or rate of fixation failure between the 2 groups, and no case of secondary shaft fracture of the femur was encountered in this study. In the entire series, there was no difference in the functional outcome (P = 0.74), but the postoperative walking ability was better in those patients with unstable fractures who were treated with the Trochanteric Gamma nail (P = 0.017). CONCLUSIONS: The new Trochanteric Gamma nail is an effective method for the treatment of trochanteric femoral fractures in elderly patients. The indication for either Trochanteric Gamma nail or compression hip screw is similar in stable fractures, but we recommend the use of the Trochanteric Gamma nail for unstable trochanteric fractures.     

Trochanteric fractures in the elderly: the influence of primary hip arthroplasty on 1-year mortality

INTRODUCTION: The aim of the study was to compare the mortality risk and complication rate after operative treatment of pertrochanteric fractures with primary arthroplasty, dynamic hip screw (DHS) or proximal femoral nail (PFN). PATIENTS AND METHODS: Clinical records including X-rays of all patients with trochanteric femoral fractures, except pathologic fractures and a minimum age of 60 years, which were treated between 1992 and 2005 were entered in this retrospective study. Of these 283 patients, 132 were treated by primary arthroplasty, 109 with a DHS and 42 with a PFN. Survival after 1 year and complications, which had to be treated within this period were our main outcome measurement. Influencing cofactors such as age, gender and comorbidities were reduced by multivariate logistic regression analysis. RESULTS: Mortality was significantly influenced by age, gender and amount of comorbidities but not by fracture classification. Primary hip arthroplasty did not bear a higher 1-year mortality risk than osteosynthesis in a multiple regression analysis. The main complication with DHS and PFN were cutting out of the hip screw and non-union with a revision rate of 12.8%. With the introduction of hemiarthroplasty, the postoperative dislocation rate decreased from 12 to 0%. CONCLUSION: For stable fractures a dynamic hip screw (DHS) and for unstable fractures a short proximal femoral nail (PFN) can be recommended. The mortality risk of primary cemented arthroplasty did not differ significantly from the other treatment groups and because of its low complication rate it is a viable treatment option for trochanteric fractures if osteoporosis prevents from full weight bearing or if osteoarthritis makes further operations likely. Primary total hip replacement should be handled with care due to its significantly higher dislocation rate compared with hemiarthroplasty especially in unstable fractures.     

动力髋螺钉与Gamma钉治疗高龄股骨转子间骨折

目的对比观察动力髋螺钉、G amm a钉治疗高龄患者股骨转子间骨折的临床疗效。方法选择2008年5月至2009年5月我院骨科收治的股骨转子间骨折患者60例,男38例,女22例;平均年龄（75±3.7）岁。根据T ron-zo-Evans分型系统,60例患者按入院顺序交替分为动力髋螺钉内固定治疗组30例及G amm a钉内固定治疗组30例。记录术中出血量、手术时间,观察骨折愈合情况,术后12个月采用H arris评分标准对患髋功能进行评估。结果所有患者均获得随访。a）G amm a钉内固定治疗组术中出血量、手术时间均少于动力髋螺钉内固定治疗组（P〈0.05）;b）动力髋螺钉内固定治疗组并发髋内翻2例,伤肢短缩1例。G amm a钉内固定治疗组未出现内固定物切出股骨头或断裂等内固定失效现象。c）髋关节H arris功能评分显示,动力髋螺钉内固定治疗组优2 2例,良5例,可3例,优良率90.0%;G amm a钉内固定治疗组优23例,良5例,可2例,优良率93.3%。两组间差异无显著性意义（P〉0.05）。结论应用动力髋螺钉、G amm a钉治疗老年股骨转子间骨折,在疗效方面无明显差异。G amm a钉可缩短手术时间、减少术中出血量及术后并发症。对于稳定性骨折,两种内固定装置均可选择;对于不稳定性骨折,G amm a钉有生物力学上的优势。     

The treatment of unstable,extracapsular hip fractures with the AO/ASIF proximal femoral nail (PFN)--our first 60 cases

The most widely used implant in unstable proximal femoral fractures is the dynamic hip screw (DHS). Intramedullary implants include the intramedullary hip screw (IHMS), gamma nail and proximal femoral nail (PFN). There have not yet been any randomised trials comparing the PFN and DHS. We report our experience of stabilising 60 consecutive proximal femoral fractures with the PFN. Fifty fractures were unstable trochanteric fractures, seven were subtrochanteric (32A), one segmental, and two were at the level of a DHS plate. The mean age was 79 years and there were 12 male and 48 female patients. Twenty-eight patients were graded as ASA 3 or 4. Two patients had multiple injuries, all fractures were closed and there were five pathological fractures. The patients were followed up for a minimum of 4 months. Within this period, there were 12 deaths due to cardiopulmonary complications. Of the remaining 48 patients, two were lost to follow-up and 39 had united by 4 months. The local complications were: four implant cut-outs, two high energy fractures below the implants and one implant failure at 7 months due to delayed union. We believe that the PFN is a good choice for stabilising subtrochanteric fractures. We also believe that the use of the PFN for unstable trochanteric fractures is very encouraging. A large, randomised controlled trial against the DHS would be helpful to clarify the relative risks and benefits.