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。

Comparison effects of unstable intertrochanteric fractures fixed with proximal femoral nail anti-rotation and Gamma nail in elderly

Objective To compare the clinical effects of proximal femoral nail antirotation （ PFNA） and Gamma nail in the treatment of unstable intertrochanteric fractures. Methods 133 cases with unstable intertrochanteric fractures were treated with the PFNA（55 cases） and Gamma nail （78 cases）respectively. The following aspects were collected for statistical analysis on,including skill of operation,postoperative complications,fracture healing and the function of hip joint. Results All cases were followed up for 6-18 months. The differences of operation time,blood loss,clini-cal healing time and post-operative restored function （ Harris score,the latest follow-up） between the two groups were not of statistical significant （P＞0. 05）. Two cases with cut-out, one with internal fixation failure, one with fracture of femoral shaft were found in the Gamma nail group. No complications were found in the PFNA group. Conclusions Both PFNA and Gamma nail are effective treatment for unstable femoral intertrochanteric fractures. Compared to Gamma nail,PFNA fixation has advantages of less interference with less post-operative complications of internal fixa-tion, it is more effective in senile patients.