改良Gamma钉手术治疗老年股骨转子间骨折

目的 探讨治疗老年股骨转子间骨折的一种改良Gamma钉手术方法及其疗效.方法 2002年3月-2006年10月,采用改良Gamma钉技术治疗股骨转子间骨折39例,其中男18例,女21例;年龄67～98岁,平均75.7岁.按AO分型:A1型6例,A2型24例,A3型9例,其中明确有骨质疏松症患者36例,占92.3%.手术方式的改良:(1)采用患侧在上的侧卧体位,患肢屈髋、屈膝60°,健肢尽屈膝屈髋.(2)采用麻醉后一次性间接牵引复位,无需持续机械牵引.(3)术中通过旋转C形臂直接获取正、侧位照片. 结果 35例获得随访,时间6个月～5年2个月,平均3年2个月.手术资料显示:手术切L1(4.3 4-1.2)cm,手术时间(46±10)min,手术失血量(65±26)ml,术中透视(3.0±2.1)次.术后康复资料显示:术后随访1年内无死亡患者,术后下床时间为(10.5±3.6)d,骨折临床愈合时间(10.9±2.1)周,术后6个月Parker评分为(6.9±3.2)分. 结论 改良Gamma钉手术可缩短手术时间、减少手术创伤和失血、降低X线暴露,从而提高手术效率,有利于老年患者术后早期康复,并有助于降低老年患者围术期的死亡率.

Treatment of intertrochantetic hip fractures with improved technique of Gamma nail in the elderly patients

Objective To explore the clinical outcome of improved technique of Gamma nail in the treatment of intertrochanteric hip fracture of the elderly patients. Methods From March 2002 to October 2006.39 patients with intertrochanteric hip fracture were operated by improved technique of Gam-ma nail.There were 18 males and 21 females at average age of75.7 years(67_98 years).There were 6 patients with type A1 fracture,24 with type A2 fracture and 9 with type A3 fracture according to AO/ASIF classification.Of all.36 patients(92.3%)had osteoporosis.The operation improvements included the following points:(1)The patients were placed at the lateral decubitus position with the fractured limb on the uppermost,with flexion of knee and hip of 60°.The normal hip and knee were flexed as possible.(2)One-off indirect traction reduction was used after general anesthesia. no requirement of continuous mechanical traction.(3)C-arm image intensifier was employed to obtain normal and lateral projections.Results Of all,35 patients were followed up for a mean period of3 years and 2 months, ranging from 6 months to 5 years and 2 months.Operation data showed incision length of(4.3±1.2)cm,mean opera-tion time of(46±10)minutes,intraoperative bleeding volume of(65±26)ml and intraoperative X-ray exposure of(3.0±2.1)times.Postoperative recovery data showed survival in one-year follow up,with ambulation time of(10.5±3.6)days and fracture union time of(10.9±2.1)weeks.Mean Parker's score wag(6.9±3.2)points 6 months after operation. Conclusions Improved technique of Gamma nail can shorten operation duration,reduce operative trauma and bleeding,reduce X-ray exposure and im-prove success rate of surgery.as facilitates early pest-operative recovery and reduces the perioperative mortality rate of the elderly.