动力髋螺钉、股骨近端防旋髓内钉和第3代Gamma钉置入内固定后生物力学性能与临床效果的比较

背景：如何选择最适合的内固定方法治疗复杂的股骨转子间骨折，是骨科医生经常面临的问题。 目的：比较动力髋螺钉、股骨近端防旋髓内钉、Gamma3三种内固定器械的生物力学性能和临床疗效。 方法：制作18具成人股骨标本制成转子间骨折模型，以动力髋螺钉、Gamma3、股骨近端防旋髓内钉固定，用实验应力分析方法，比较其生物力学性能。另外回顾分析392例股骨转子间骨折患者采用以上3种内固定方法的临床效果。 结果与结论　应力分析结果证明，Gamma3和股骨近端防旋髓内钉的力学性能优于动力髋螺钉(P < 0.05)，Gamma3与股骨近端防旋髓内钉无明显差别。临床试验结果显示，动力髋螺钉组患者术中平均失血量最多、内固定后并发症发生率最高(P < 0.05)。内固定后髋关节早期Harris评分股骨近端防旋髓内钉组和Gamma3组优于动力髋螺钉组(P < 0.05)，远期评分3组差异无显著性意义(P >0.05)。提示A2型骨折不推荐使用动力髋螺钉；A2型伴随明显骨质疏松和A3型应采用股骨近端防旋髓内钉或Gamma3。股骨近端防旋髓内钉、Gamma3内固定器械生物力学性能优良，临床证实是目前比较理想的方法。

Comparison of biomechanical and clinical effects among dynamic hip screw, proximal femur nail antirotation and Gamma3

BACKGROUND: BACKGROUND: How to choose an appropriate internal fixation method for the treatment of intertrochanteric fracture of femur is a common problem in clinic. OBJECTIVE: To compare the biomechanical functions and clinical effects of dynamic hip screw (DHS), proximal femur nail antirotation (PFNA) and the third generation Gamma nail (Gamma3). METHODS: A total of 18 fresh specimens of proximal femur were prepared into models of intertrochanteric fracture, which were fixed with DHS, PFNA and Gamma3. The different internal fixation methods were tested and proved by means of experiment stress analysis. Clinical effects of 392 cases of intertrochanteric fracture of femur undergoing fixation with the above three methods were retrospectively analyzed. RESULTS AND CONCLUSION: The stress analysis proved that the biomechanical functions of Gamma3 and PFNA were better than DHS (P < 0.05). There was no obvious difference between Gamma3 and PFNA. The DHS group had the most average intraoperative bleeding and greatest incidence of complications related with internal instrument (P < 0.05). The Harris score of the PFNA and Gamma3 groups in earlier period was better than the DHS group (P < 0.05). There was no obvious difference in the long-term scores between the three groups (P > 0.05). DHS is not recommended for the treatment of the type-A2 intertrochanteric fractures. PFNA and Gamma3, which present excellent biomechanical nature and clinical effects, especially are suitable for the osteoporotic patients of type-A2 or type-A3 intertrochanteric fractures.