股骨转子周围骨折的髓内钉固定96例

应用国产Ｇａｍｍａ钉治疗股骨转子周围骨折９６例（９７髋）的疗效。对稳定性骨折４０例、不稳定性股骨转子周围骨折５６例（５７髋）采用亚太型Ｇａｍｍａ钉治疗。平均随方１２个月,骨折愈合率９８％,髋关节功能优良率９０．２％。并发症：股骨干骨折、拉力螺钉切出股骨头及奶出各１例,迟发感染３例。Ｇａｍｍａ钉可用于各种类型的股骨转子周围骨折,具有操作简便、手术损伤小、出血少、固定牢固等优点。熟练掌握Ｇａｍｍａ钉主     

交锁钉治疗股骨转子骨折32例报告

１９８９年１２月，我们参阅了Ｇａｍｍａ Ｌａｃｋｉｎｇ Ｎａｉｌ的资料并改良制成交锁钉和手术器械，治疗股骨转子骨折３２例。术后６－１３天病人可离床活动，钉无折弯或断裂，未发生伤口感染或并发症。２９例随访５－１９个月，骨折全部愈合，髋关节恢复灰复功能。２例髋内翻和１例患肢缩短２．５ｃｍ。我们认为该钉符合物力学原理，适用于治疗各种类型的股骨转子骨折，骨折固定牢靠。     

两种髓内钉治疗股骨转子间骨折的回顾性分析

目的：比较自制股骨颈轴向控制髓内钉（axial controlled intramedullary nail of the femoral neck简称ACINFN钉）与A-P型Gamma钉治疗股骨转子间骨折的远期疗效。方法：运用影像学，术后患肢功能和术后并发症对48例ACINFN钉，66例A-P型Gamma钉术后随访进行综合评定。结果：ACINFN钉术后解剖复位率83.33%，髋关节功能优良率达93.75%。术后并发症；异位骨化4例，占8.33%；异物残留1例，占2.08%；无内固定断裂，颈螺钉穿出股骨头，髋内翻和继发性股骨骨折等严重并发症发生。明显优于A-P型Gamma钉。结论：ACINFN钉具有创伤小，解剖复位率高，髋关节功能恢复好和并发症少的优点，不失为治疗股骨转子周围部骨折可供选择的方法之一。     

两种髓内钉治疗股骨转子间骨折的回顾性分析

目的比较自制股骨颈轴向控制髓内钉(axial controlled intramedullary nail of the femoral neck简称ACINFN钉)与A-P型Gamma钉治疗股骨转子间骨折的远期疗效.方法运用影像学,术后患肢功能和术后并发症对48例ACINFN钉,66例A-P型Gamma钉术后随访进行综合评定.结果ACINFN钉术后解剖复位率83.33%.髋关节功能优良率达93.75%.术后并发症异位骨化4例,占8.33%;异物残留1例,占2.08%;无内固定断裂、颈螺钉穿出股骨头、髋内翻和继发性股骨骨折等严重并发症发生.明显优于A-P型Gamma钉.结论ACINFN钉具有创伤小,解剖复位率高,髋关节功能恢复好和并发症少的优点,不失为治疗股骨转子周围部骨折可供选择的方法之一.     

全锁髓内钉的设计及其临床应用

锁式髓内钉是近十余年来国际上有关髓内钉骨折内固定技术的三大进展之一。我院骨科在参考Ｈｕｃｋｓｔｅｐ钉的基础上，设计了改进型Ｈｕｃｋｓｔｅｐ钉（即全锁髓内钉，简称全锁钉，下同）及其手术器械和手术方法，不需要Ｘ线辅助设备，用于治疗复杂股骨骨折。自１９８７年４月～１９９２年１２月用全锁钉治疗复杂股骨骨折４８例，其中男３３例、女１５例；年龄最大５５岁，最小２０岁，平均３４．６岁。致伤原因：车祸２１例、高处坠落伤１４例、工业伤１０例、其他３例。骨折部位：股骨干上１／３骨折１７例、中１／３骨折４例、下１／３骨折５例、全股骨多处骨折５例（其中股骨骨折合并股骨颈骨折３例、合并转子间骨折和转子下骨折各１例）、股骨转子间骨折１２例，股骨转子下骨折５例。４８例中３９例获得随访，最长１０７个月，最短４２个月，平均６６．４个月。优３０例（７６．９％），良７例（１８．０％），失败２例（５．１％）。     

Gamma钉与滑动加压鹅头钉治疗股骨转子周围骨折的比较

自１９８８年以来，作者分别应用国产Ｇａｍｍａ钉和滑动加压鹅头钉治疗股骨转子周围骨折５０例（５１髋）和９４例。通过比较认为，两种手术方法的平均住院日、术后并发症及关节恢复情况相似。术后随访时间分别为４～３０个月和６～６０个月，平均１６个月和２８个月。随访６个月以上共１３０例，所有骨折均愈合。关节功能优良率分别为９３．２％和９４．２％。Ｇａｍｍａ钉组的平均手术时间、切口长度、输血量及术后引流量显著低于滑动加压鹅头钉组（Ｐ值＜０．０５）。Ｇａｍｍａ钉作为一种新的股骨转子周围骨折的治疗技术，具有操作简单、固定牢固、手术损伤小、失血少、感染率低等优点，值得应用和推广。     

股骨转子间骨折的治疗方法选择(附1037例分析)

目的通过比较保守疗法与不同手术方法治疗股骨转子间骨折的疗效及术后并发症，探讨股骨转子间骨折的手术适应证。方法1980年1月～2005年12月共收治1037例股骨转子间骨折患者，其中216例采用保守治疗，行骨牵引、皮肤牵引或髋“人”字石膏固定；手术治疗821例：集柬针固定28例，空心螺钉固定33例，Ender钉固定98例，动力髋螺钉（DHS）固定411例。动力髁螺钉（DCS）固定86例，Gamma钉固定52例，股骨近端螺钉（PFN）固定17例，人工关节置换26例，角钢板固定70例。结果972例获得随访的患者中，保守治疗组176例；集柬针固定组28例，空心螺钉固定组32例，Ender钉固定组93例，DHS固定组392例，DCS固定组86例，Gamma钉固定组52例，PFN固定组17例，人工关节置换组26例，角钢板固定组70例，其优良率分别为52．8％、67．9％、87．5％、77．4％、95．9％、93．O％、90．4％、88．2％、92．3％、84．3％。保守治疗组死亡11人，肺部感染7例，尿路感染4例，髋内翻35例。集柬针固定组髋内翻3例，钉退出4例。Ender钉固定组髋内翻3例，切口感染3例。DHS固定组死亡1例，尿路感染3例，肺部感染3例，螺钉松动2例。DCS固定组内固定断裂1例。Gamma钉固定组螺钉松动1例。人工关节置换组死亡1例。角钢板固定组断裂1例。结论保守治疗髋内翻及内科并发症发生率高。逆股骨转子间骨折采用DCS、Gamma钉或PFN固定，DHS适用于稳定性骨折，四者对股骨转子间骨折的疗效确切，且并发症发生率低。     

改良Gamma钉和Ender钉治疗股骨转子间骨折的疗效比较

作者采用改良Ｇａｍｍａ钉和Ｅｎｄｅｒ钉两种方法治疗股骨转子间骨折１０２例。Ｇａｍｍａ钉组６０例，Ｅｎｄｅｒ钉组４２例。术后随诊１．５～４年，将两组手术资料和术后资料进行统计学分析，结果显示改良Ｇａｍｍａ钉组的临床疗效明显优于Ｅｎｄｅｒ钉组；其手术合并症少于Ｅｎｄｅｒ钉；改良Ｇａｍｍａ钉的手术创伤比Ｅｎｄｅｒ大。经改良的Ｇａｍｍａ钉手术是一种值得推广的治疗股骨转子间骨折的新方法，但是，对于超高龄合并有重要脏器功能部分不全者，不宜选用改良Ｇａｍｍａ钉，而Ｅｎｄｅｒ钉是可供选择的治疗方法。     

改良Gamma钉手术治疗股骨转子周围部骨折

作者对Ｇａｍｍａ钉系统做了如下主要的改进：（１）钉的尺寸改小以适合国人，原髓内棒上段弯度取消，改为纵内切斜面８°，颈螺钉改为真正的拉力钉，远瑞交锁螺钉改用１枚；（２）瞄准器由多部件接合体改为半固定结合体，设有校准程序；（３）采用改良三点显露法使开放复位、安装髓内棒和颈螺钉在同一个小切口内完成；（４）术中不用放射性检查或仅在确定颈螺钉深度时使用。采用改良Ｇａｍｍａ钉手术治疗７３例股骨转子周围部骨折，术后随诊５～３８个月，通过放射学及临床评价，疗效满意。此法有提高复位内固定质量，减少并发症，允许早期负重，不用顾虑术者接受累积放射性损害的优点。     

改良型Gamma钉的临床应用

旨在探讨Ｇａｍｍａ钉的改进和临床应用情况。作者在尸体股骨标本和髓腔石蜡铸型标本上进行了股骨上段的解剖测量。在此基础上对Ｇａｍｍａ钉进行了改进：（１）将其粗端１７ｍｍ改为１４ｍｍ，细端１３ｍｍ改为１０ｍｍ，两者间的角度由１１度改为５～６度；（２）改良型的加压螺钉具有自攻加压作用；（３）研制出加长型Ｇａｍｍａ钉。临床应用３１例，其中２８例平均随访２０个月，骨折愈合优良率为９３％，不扶拐行走优良率为８６％，髋关节活动优良率为８２％，术后平均９～１１天下地活动。作者认为Ｇａｍｍａ钉对Ｉ、ＩＩ型粗隆间骨折更适用。     

Ipsilateral hip and distal femoral fractures

We tried to find the trauma mechanism and treatment rationale of ipsilateral concomitant hip and distal femoral fractures involving the articular surface. Between 1988 and 1995, 15 cases of ipsilateral hip (confined to neck or trochanteric areas of the femur) and distal (confined to supra- and intercondylar area of the femur) femoral articular fractures were collected. The hip fractures consisted of 10 trochanteric fractures and five neck fractures, which were managed with reduction and fixation in 14 (Knowles' pin in eight, DHS in four and standard Gamma nail in two), and primary bipolar hemiarthroplastry in one. The distal femoral articular fractures were open in 11; these were managed with radical debridement, implantation of Septopal chains and immediate internal fixation, followed by prophylactic autogenous bone grafting 6 weeks later in the recent six cases (five Judet plates, four dynamic condylar screws and two condylar plates). The other four closed distal femoral fractures were managed with early reduction and internal fixation (two Judet plate, one dynamic condylar screw and one condylar plate). The union time was 20.3 (12-48) weeks for proximal fractures and 23.7 (12-36) weeks for distal fractures. Early infection developed in three cases. Nonunion of a femoral neck fracture developed in one case. The other complications were implant failure in one, coxa vara in one, refracture in one, delayed union in one and knee stiffness in one.     

股骨转子周围骨折的髓内钉固定96例

应用国产Gamma钉治疗股骨转子周围骨折 96例 (97髋 )的疗效。对稳定性骨折 4 0例、不稳定性股骨转子周围骨折 56例 (57髋 )采用亚太型Gamma钉治疗。平均随访 1 2个月 ,骨折愈合率 98% ,髋关节功能优良率 90 2 %。并发症 :股骨干骨折、拉力螺钉切出股骨头及退出各 1例 ,迟发感染 3例。Gamma钉可用于各种类型的股骨转子周围骨折 ,具有操作简便、手术损伤小、出血少、固定牢固等优点。熟练掌握Gamma钉技术 ,术中认真、细致操作 ,有些并发症是可以避免的。Gamma钉是治疗股骨转子周围骨折的理想方法之一。     

Early experience with the gamma interlocking nail for peritrochanteric fractures of the proximal femur.

Surgical fixation, early weight-bearing, and bony union remain a challenge in the treatment of peritrochanteric femur fractures, especially if the fractures are comminuted or unstable. Preliminary experience with the Gamma locking nail, a short intramedullary nail connected to a sliding compression screw augmented with distal locking screws, is presented. In a consecutive series of 29 patients, all fractures were adequately reduced and immediate weight-bearing was begun regardless of fracture configuration (13/27 fractures classified as unstable). Twenty-seven patients were reviewed at 6 months. At follow-up, all patients continued to be ambulatory and all fractures healed. Major complications included screw migration in the femoral head (two patients), difficulty in securely placing the distal screws (eight patients), and a femoral shaft fracture through the distal locking screws following a fall. The technical problems inherent in the device and its instrumentation are discussed. In this early experience, the Gamma nail appears to allow for early patient ambulation regardless of the fracture configuration with excellent clinical results.     

青少年型锁定髓内钉治疗儿童股骨干骨折的疗效

目的评估青少年型锁定髓内钉治疗儿童股骨干骨折的疗效。方法采用经大转子外侧置入锁定髓内钉治疗21例儿童股骨干骨折。评估患侧髋、膝关节的功能,测量双下肢长度、股骨颈干角及股骨颈直径,记录切口感染、股骨头缺血性坏死、髋外翻和股骨颈狭窄等并发症发生情况。结果患儿均获得随访,时间8~34个月。骨折均愈合,时间10~28周。术后6个月患肢髋、膝关节未见活动受限,无明显旋转畸形。末次随访时下肢长度、股骨颈直径和股骨颈干角患侧与健侧比较差异均无统计学意义(P>0.05)。无切口感染、股骨头缺血坏死、髋外翻、股骨颈狭窄等并发症发生。结论经大转子外侧置入青少年型锁定髓内钉治疗儿童股骨干骨折是一种安全有效的方法。     

复杂股骨粗隆间骨折的手术治疗

目的 探讨治疗复杂性股骨粗隆间骨折的手术方法，以提高手术疗效。方法 对我科自1995年～2004年收治48例复杂的股骨粗隆间骨折病人分别采用DHS（动力髋螺钉），DCS（动力髁螺钉）和Gamma钉治疗进行回顾性分析。结果 本组病人手术后无切口感染及其它手术后并发症。术后随访10个月至18个月，手术后优良率达93．3％．仅3例发生髋骨翻。结论 对于复杂的股骨粗隆间骨折，要视不同的情况采用不同的方法处理。DHS为股骨粗隆间骨折固定的常用方法，在使用中要强调股骨距，小转子的复位和固定。DCS适合于不稳定粗隆间骨折（A3型），Gamma适合于严重的粉碎性骨折（A2型）。     

Comparison of standard versus reconstruction proximal interlocking screw configurations for antegrade intramedullary nail fixation of femoral shaft fractures

BackgroundThe standard proximal interlocking screw (SS) configuration for antegrade intramedullary nail (IMN) fixation of femoral shaft fractures is lateral to medial or from the greater to less trochanter. Some authors argue for the routine use of the reconstruction screw (RS) configuration (oriented up the femoral neck) instead to prevent femoral neck complications. The purpose of this study was to compare a matched cohort of patients receiving these screw configurations and subsequent complications.MethodsA retrospective review of two urban level-one trauma centers identified adults with isolated femoral shaft fractures undergoing antegrade IMN. Patients with RS and SS configurations were matched 1:1 by age, sex, fracture location, and AO classification in order to compare complications.Results130 patients with femoral shaft fractures were identified. SS and RS configurations were used in 83 (64%) and 47 (36%) patients. 30 patients from each group were able to be matched for analysis. The RS and SS group did not differ in age, fracture location, AO classification, operative time, or number of distal interlocking screws. The RS group had fewer open fractures and were more likely to have two proximal screws. There were 7 complications, including 5 nonunions and 2 delayed unions, with no detectable difference between RS vs. SS groups (10% vs 13%, Proportional difference −3%, 95% confidence interval (CI) −30 to 14%, p = 0.1). There were no femoral neck complications in the entire cohort of 130 patients. On multivariate analysis none of the variables analyzed were independently associated with the development of complications.ConclusionsIn this matched cohort of patients with femoral shaft fractures undergoing antegrade IMN fixation, RS and SS configurations were associated with a similar number of complications and no femoral neck complications. The SS configuration remains the standard for antegrade IMN femoral shaft fixation.Level of evidenceLevel III, Retrospective cohort study.     

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。     

Le fratture del femore prossimale in età pediatrica

Proximal femoral fractures are rare in children; however, they are associated with a high rate of complications. They are the consequence of high energy trauma following motor vehicle accidents and falls from greater heights. The ideal treatment for displaced fractures should include anatomical reduction and stable fixation, if possible within 24 hours from the trauma in order to reduce the incidence of sequelae. Adequate fixation may be obtained using Kirschner wires, cannulated screws, plates and screws or external fixators, depending on the type of fracture. Complications include avascular necrosis of the femoral head, coxa vara, nonunion, premature physaeal closure and limb discrepancy.