Gamma钉与人工股骨头置换修复老年股骨转子间粉碎性骨折的比较

背景：近年国内外有较多文献报道对比内固定与人工股骨头置换治疗老年股骨转子间骨折的疗效，意见均不统一；并且较多文献内固定治疗包含Richard钉、鹅头钉及动力髋等髓外固定方法，可能导致结论不准确。目的：通过 Gamma钉内固定与人工股骨头置换治疗老年股骨转子间骨折的临床指标的比较，探讨人工股骨头置换治疗股骨转子间骨折的经验，适应证及置换后并发证的处理。 方法：回顾性分析154例80岁以上股骨转子间粉碎性骨折的老年患者；其中98例患者采用Gamma钉内固定治疗，56例患者采用人工股骨头置换治疗，对比分析两组患者手术时间、住院天数、手术中出血量及离床活动时间；末次髋关节功能恢复情况（根据 Harris 评分）和内固定后并发症的发生率；将所得结果进行比较和评估，并进行统计学分析。 结果与结论：Gamma钉组平均随访时间为6.6年；人工股骨头组平均随访时间为5.7年。两组数据在手术时间、住院天数及手术中出血量方面比较，差异无显著性意义（P 〉0.05），离床活动时间差异有显著性意义（P 0.05）；内固定后并发症：深静脉血栓形成、肺部感染及泌尿系感染方面，差异无显著性意义（P 〉0.05）；内固定后置入物松动断裂或假体松动、下沉、脱位，以及双下肢不等长方面，差异有显著性意义（P 〈0.05）。选用人工股骨头置换治疗老年股骨转子间骨折患者，有助于患者早期离床活动，改善患者部分生活质量；人工股骨头置换后髋关节功能恢复较 Gamma 钉内固定无明显差异；但早中期并发症的发生率较低；出现假体松动、下沉及脱位等严重并发症后，处理较为困难，对患者日常生活影响较大，需严格掌握其手术适应证及手术技巧。

Gamma nailversus artificial femoral head replacement for intertrochanteric comminuted fractures of femur in the elderly

BACKGROUND：In recent years, many literatures compared the therapeutic effects of internal fixation and artificial femoral head replacement for treatment of intertrochanteric fractures of femur in the elderly, but their opinions are not uniform. Moreover, many literatures concerned the internal fixations including Richard screw, goose head nail and dynamic hip screw, which may lead to inaccurate conclusions. OBJECTIVE：To compare the results of Gamma nail and artificial femoral head replacement for intertrochanteric fractures of femur in the elderly, to explore the experiences, indications and complications about artificial femoral head replacement for the intertrochanteric fractures. METHODS： This study retrospectively analyzed 154 elder patients aged over 80 years old with intertrochanteric comminuted fractures. Of them, 98 cases underwent Gamma nail fixation and 56 cases underwent artificial femoral head replacement. Operation time, hospitalization day, intraoperative bleeding, off-bed time, final hip joint function recovery （Harris score） and incidence of complications after fixation were compared and evaluated for statistical analysis. RESULTS AND CONCLUSION：Average folow-up periods were respectively 6.6 years and 5.7 years in the＆nbsp;Gamma nail group and artificial femoral head group. No significant difference in operation time, hospitalization day and intraoperative bleeding was detected between the two groups （P 〉 0.05）, but significant difference in off-bed time was detectable （P 0.05）. No significant differences in complications after fixation such as deep vein thrombosis, pulmonary infection and urinary tract infection were visible between the two groups （P 〉 0.05）. Significant differences in implant loosening or rupture, subsidence, dislocation and inequality in leg length were detected between the two groups （P 〈 0.05）. Artificial femoral head replacement for intertrochanteric fractures of femur in the elderly was helpful to patient’s off-bed activities and improved partial patients’ quality of life. After artificial femoral head replacement, no significant difference in hip joint function recovery was detectable compared with Gamma nail fixation. However, the incidence of early- and middle-stage complications was low. Prosthetic loosening, subsidence and dislocation appeared, and these were difficult to be handled and greatly impacted patient’s daily life. Operation indications and skils should be mastered strictly.