第三代Gamma钉微创治疗股骨转子周围骨折

目的 探讨第三代Gamma钉微创治疗股骨转子周围骨折的方法.方法 2006年5月至2006年12月,采用第三代Gamma钉治疗股骨转子周围骨折患者20例,男14例,女6例;年龄19～83岁,平均65.5岁.受伤原因:车祸伤2例,高处坠落伤2例,步行跌伤16例.AO分型:A1型3例,A2型13例,A3型4例.采用Singh分级评定骨质量:Ⅵ级5例,Ⅴ级4例,Ⅳ级9例,Ⅲ级2例.骨折采用闭合复位,第三代Gamma钉固定术.结果 平均手术时间38.3 min(30～70 min).术中平均失血量170 ml(100～500 ml).5例患者术中须扩髓后放入主钉,15例患者无须扩髓即可放入主钉.17例患者静力交锁远端螺钉,3例患者未交锁远端螺钉.患者平均部分负重时间7.4 d(2～23 d).TAD平均值是23.5mm(12.5～36.1 mm).随访时间6.7～13.4个月,平均9.6个月.20例患者伤口均一期愈合,无一例出现皮缘坏死和伤口感染.20例患者主钉入点切口平均2.73 cm(2～3.5 cm).骨折愈合时间3.2～5.9个月,平均4.6个月.全部患者的术后功能均恢复到伤前水平.1例患者术后出现拉力螺钉切出移动,1例患者主钉入点偏外导致10°内翻畸形,1例患者主诉患侧臀部和大转子区疼痛.结论 通过微创操作技术,第三代Gamma钉可以安全地固定股骨转子周围骨折.

Treatment of peritroc hanteric fractures with the Gamma 3 nail

Objective To explore the clinical outcome of minimal invasive treatment of peritrochanterie fractures with the Gamma 3 nail.Methods Twenty patients for peritrochanteric fractures of the femur were treated with Gamma 3 nail from May 2006 to December 2006.There were 14 males and 6 females with an average age of 65.5 years(ranged from 19 to 83 years).Mechanism of injury:traffic accident in 2 cases,fall injury in 2 eases and pedestrian injury inl 6 eases.AO classification:A1 type in 3 cases.A2 type in 13 cases,A3 type in 4 case.The quality of the bone was rated by the Singh index:grade Ⅵ in 5 cases,grade Ⅴ in 4 cases,grade Ⅳ in 9 cases and grade Ⅲ in 2 eases.The fractures were reducted with closed reduction technique and fixed with Gamma 3 nail.Results The mean operative time was 38.3 min (30-70 min).The mean operative blood loss was 170 ml (100-500 ml).Reaming in 5 cases and unreaming in 15 cases during operative procedure.With static distal locking nail in 17 cases and without distal 1ooking nail in 3 eases.The median time to partieal weight-bearing was 7.4 d(2-23 d).The average TAD value was 23.5 mm(12.5-36.1 mm).The mean duration of follow up was 9.6 months(6.7-13.4 months).The wound healing was smoothly in 20 patients.None edge of skin necrosis and none infection of skin.The mean invision length nail inserted was 2.73 cm(2-3.5 cm).The average time of fracture healing was 4.6 Inonths (3.2-5.9 months) Fhe postoperative function was recovered to premorhid status in all patients.One patient occurred the migration of cut-out of lag screw postoperatively.One patient suffered varuS deformity in 10°due to the lateral entrying pomt of the main nail.One patient complained the injuried buttock and great troehanter pain.Conclusion Gamma 3 nail can fixed peritrochanteric fractures safely by minimal invasive technique.