改良型Gamma钉治疗股骨转子间骨折远期疗效观察和并发症分析

目的：综合评估改良型Ｇａｍｍａ钉治疗股骨转子间骨折的远期疗效，并分析并发症发生原因。方法：对术后平均２．７年的３９例患者进行随访，采用主观症状、客观体征和双下肢功能评分，按得分评定疗效。统计本组５７例患者发生的并发症。结果：患者远期疗效优良率达到８１．６％。并发症中伤口问题（脂肪液化１例，血肿２例，感染１例）占７．０％；大转子继发骨折３例，占５．３％；加压螺钉穿出股骨头和髋内翻畸形各有２例（各占３．５％）；异位骨化３例（５．３％）；内固定断裂１例（１．８％）；术后股骨继发性骨折１例（１．８％）。结论：（１）改良型Ｇａｍｍａ钉手术损伤小，可减少患者住院和卧床时间，患者下地早、恢复快，是治疗此种骨折的有效方法。（２）大转子继发骨折和异位骨化对手术疗效影响不大。（３）加压螺钉穿出股骨头、严重髋内翻畸形、内固定断裂和继发股骨骨折是较严重的并发症，需二次手术。（４）术后继发股骨骨折与钉体设计、手术方法和患者再损伤有关，作者建议骨折愈合后应尽早拔钉。

Evaluation of the Complications and Long-term Results in Patients with Femoral Intertrochanteric Fractures Treated by Modified Gamma ZNail

Objective: Thirty-nine patients with femoral intertrochanteric fractures (FIF) treated by modified Gamma nail (MGN) and with an average of 2.7 years follow-up were studied in order to evaluate its curative effects and the causes of complications. Methods: Based on patient's symptoms, signs and function of their lower extremities, a score system has been established. Results: 81.6% of patients achieved excellent and good results. The complications included wound problems (7.0% , fatty liquation in 1 , hematoma in 2 and infection in 1), secondary fractures of greater trochanter in 3 (5.3% ) , penetration of compression screws though the femoral head in 2 ( 3.5% ) , coxa vara in 2 ( 3.5% ) , heterotopic ossification in 3 ( 5.3% ) , the fixation failure in 1 ( 1.8% )and secondary femoral shaft fracture in 1 ( 1.8% ) . Conclusion: MGN was considered as an effective means of treatment of FIF, with early ambulance and short time of hospitalization and bed rest. Secondary fractures of gareater trochanter and heterotopic ossification seemed to have little effects on the final results. Penetration of compression screws, severe coxa vara, fixation failure and secondary femoral shaft fractures were severe complications, which usually needed revision operation. The secondary femoral shaft fractures were closely associated with the configuration of Gamma nail, operative method and reinjury to the hip. The authors propose that MGN should be removed as soon as the fracture healed.