稳定股骨粗隆间骨折Gamma髓内钉内固定术中远端锁钉与否对疗效的影响

目的评估稳定股骨粗隆间骨折Gamma髓内钉内固定术中远端锁钉与否对疗效的影响。方法纳入自2014-01—2016-12行Gamma髓内钉内固定治疗的143例稳定股骨粗隆间骨折,71例远端未采用锁定螺钉固定(观察组),72例远端采用锁定螺钉固定(对照组)。结果 143例均获得12个月随访,切口均一期愈合,随访期间骨折均获得骨性愈合。观察组手术时间、术中透视时间明显较对照组短,输血量较对照组少,术后1 d血红蛋白水平较对照组高,差异有统计学意义(P <0.05);观察组与对照组骨折复位质量、住院时间、骨折愈合时间、并发症发生率、末次随访时髋关节功能Harris评分比较差异无统计学意义(P>0.05)。结论采用Gamma髓内钉内固定治疗稳定股骨粗隆间骨折时髓内钉远端可以不采用锁定螺钉固定,不影响骨折愈合和临床疗效,同时还具有减少术中透视时间、手术时间、术后并发症等优点。     

股骨近端防旋髓内钉和Gamma钉治疗老年不稳定型股骨转子间骨折疗效比较

目的比较股骨近端髓内钉和Gamma钉治疗老年不稳定股骨转子间骨折的疗效。方法将133例老年不稳定股骨转子间骨折患者按内固定方法分为股骨近端髓内钉(PFNA)组55例和Gamma钉组78例。比较两组的手术技巧、术后并发症、骨折愈合情况和髋关节功能。结果两组患者均获随访,时间6~18个月。两组在手术时间、术中出血量、骨折愈合情况及髋关节功能(末次随访Harris评分)比较差异均无统计学意义(P0.05)。Gamma钉组出现2例髋螺钉切割,1例远端锁钉断裂,1例股骨干骨折;PFNA组无相关并发症发生。结论 PFNA和Gamma钉均是治疗老年不稳定型股骨转子间骨折的理想方法。与Gamma钉相比,PFNA显著降低了术后并发症,更适用于治疗老年骨质疏松性不稳定型股骨转子间骨折。     

两种方法治疗老年股骨转子间骨折的疗效比较

目的比较防旋股骨近端髓内钉(PFNA)与股骨转子间顺行髓内钉(InterTAN)治疗老年股骨转子间骨折的临床疗效。方法将141例老年股骨转子间骨折患者根据内固定材料不同分为PFNA组(87例,采用PFNA治疗)和InterTAN组(54例,采用InterTAN治疗)。比较两组患者手术时间、术中出血量、术后输血例数、输血量、骨折愈合时间、内固定相关并发症发生例数、末次随访Harris评分等级、术后下肢深静脉血栓(DVT)发生率。结果手术时间PFNA组短于InterTAN组(P<0.05)。两组术中出血量、术后输血例数和输血量比较差异无统计学意义(P>0.05)。两组患者均获得随访,时间6~18个月。骨折均骨性愈合,骨折愈合时间PFNA组长于InterTAN组(P<0.05)。两组末次随访Harris评分等级、术后下肢DVT发生率及内固定相关并发症发生率比较差异无统计学意义(P>0.05)。结论PFNA与InterTAN均为治疗老年股骨转子间骨折的理想选择,PFNA手术时间更短,而InterTAN术后骨折愈合时间更短。     

三种内固定方法在股骨转子间骨折中的应用分析

目的比较130°角度钢板、加压滑动鹅头钉及Gamma钉治疗股骨转子间骨折的临床疗效。方法对采用以上三种内固定治疗股骨转子间骨折139例患者的手术时间、术中失血量、住院时间、手术并发症及功能优良率进行了临床疗效分析。结果Gamma钉组疗效最好,手术并发症少,功能优良率明显优于另两组。结论Gamma钉内固定术对老年人股骨转子间骨折是一种行之有效的方法,与其它方法相比较,此内固定物更符合人体生物力学原理,更有利于骨折部位的愈合及髋关节功能的恢复,是目前治疗股骨转子间骨折比较理想的内固定材料。     

Othofix转子间外固定架治疗老年股骨转子间骨折疗效观察

目的探讨Othofix转子间外固定架治疗老年股骨转子间骨折的临床疗效。方法回顾分析2012年10月-2015年3月,采用闭合复位Orthofix转子间外固定架治疗的36例老年股骨转子间骨折患者(外固定架组)临床资料,并与同期行闭合复位Gamma钉内固定治疗的47例股骨转子间骨折患者(Gamma钉组)进行比较。两组患者性别、年龄、致伤原因、侧别、骨折AO分型、合并内科疾病及受伤至手术时间等一般资料比较差异均无统计学意义(P0.05),具有可比性。记录并比较两组患者手术时间、术中失血量、住院时间、骨折愈合时间及并发症等;术后根据Sanders髋关节创伤后功能评定标准进行髋关节功能评分。结果外固定架组患者手术时间、术中失血量及住院时间均显著低于Gamma钉组(P0.05)。两组患者均获随访,随访时间6~12个月,平均8.8个月。术后两组患者切口均Ⅰ期愈合。外固定架组和Gamma钉组骨折均获骨性愈合,愈合时间外固定架组明显少于Gamma钉组(t=14.780,P=0.000)。两组均无骨道感染、骨髓炎等深部感染发生。外固定架组14例(38.9%)出现轻微表浅软组织钉道感染,Gamma钉组未出现切口感染,两组比较差异有统计学意义(χ2=22.010,P=0.001)。外固定架组出现轻度髋内翻3例(8.3%)、半针切出2例(5.6%),Gamma钉组分别为4例(8.5%)和3例(6.4%),两组并发症发生率比较差异无统计学意义(χ2=0.001,P=0.960;χ2=0.025,P=0.830)。术后6个月根据Sanders髋关节创伤后功能评定标准评价,外固定架组优16例、良15例、可3例、差2例,优良率86.1%;Gamma钉组优22例、良20例、可4例、差1例,优良率89.4%;两组比较差异无统计学意义(χ2=0.200,P=0.610)。结论闭合复位Othofix转子间外固定架治疗老年股骨转子间骨折具有手术时间短、操作简便、出血量少、固定可靠、手术风险小、患者术后恢复快等优点,临床效果满意。     

Gamma钉和股骨近端防旋髓内钉治疗股骨转子间骨折的疗效比较

目的比较Gamma钉、股骨近端防旋髓内钉(PFNA)治疗股骨转子间骨折的疗效。方法对162例接受髓内钉系统治疗的股骨转子间骨折患者的临床资料进行回顾性分析,其中Gamma钉治疗82例,PFNA治疗80例。对两组术中出血量、手术时间、骨折复位和骨折愈合情况及髋关节功能进行比较。结果两组的手术时间、术中出血量比较差异均无统计学意义(P0.05)。死亡及失访30例,132例获得随访,时间6~48个月。两组骨折愈合时间及髋关节功能优良率比较差异均无统计学意义(P0.05);骨折复位情况Gamma钉组优于PFNA组(P0.05)。结论 Gamma钉和PFNA治疗股骨转子间骨折操作简单,手术时间较短,术中出血量较少,疗效均较好。     

DHS、DCS、Gamma钉固定不稳定股骨转子间骨折的临床对比分析

目的:探讨DHS、DCS、Gamma钉固定不稳定股骨转子间骨折的临床对比效果。方法:不稳定股骨转子间骨折住院患者180例随机分为DHS组、DCS组、Gamma钉组各60例后进行上述内固定治疗。结果:所有患者手术切口均一期甲级愈合,术后患者康复出院。不过Gamma钉组髋内翻、深部感染、髋关节脱位、螺钉切割等并发症发生率明显少于其他两组(P<0.05)。Gamma钉组的术后卧床时间少于其他两组,同时术后6个月髋关节Harri s评分及脊髓神经损伤分级情况也优于其他两组(P<0.05)。结论:不稳定型转子间骨折应首选内固定治疗,Gamma钉固定能取得很好的效果,是理想的手术方法。     

4种手术方法治疗老年骨质疏松性股骨转子间骨折疗效分析

目的比较DHS、股骨近端解剖型锁定钢板、Gamma钉和PFNA 4种内固定方法治疗老年骨质疏松性股骨转子间骨折的临床效果。方法对108例老年骨质疏松性股骨转子间骨折患者分别采用DHS(30例)、股骨近端解剖型锁定钢板(18例)、Gamma钉(22例)和PFNA(38例)治疗,比较4组手术情况、术后并发症、骨折愈合时间及临床疗效。结果 108例患者均获得随访,时间6～36个月。4组内固定方法手术时间、术中出血量比较差异有统计学意义(P<0.05)。术后并发症比较差异无统计学意义(P>0.05)。骨折愈合时间:DHS组(13.0±1.9)周,锁定钢板组(13.5±3.3)周,Gamma钉组(12.5±2.0)周,PFNA组(12.0±2.8)周,差异无统计学意义(P>0.05)。根据髋关节Harris评分标准评定功能:DHS组(85.6±5.3)分,优良率86.7%;锁定钢板组(86.1±6.5)分,优良率83.3%;Gamma钉组(88.2±4.2)分,优良率90.9%;PFNA组(89.3±3.8)分,优良率92.1%;4组比较差异无统计学意义(P>0.05)。结论对于稳定型骨折应用4种内固定方法皆可;对于不稳定型骨折宜选用Gamma钉和PFNA;PFNA尤其适用于不稳定型骨质疏松性股骨转子间骨折。     

PFNA和Gamma钉治疗股骨转子间骨折的疗效分析

目的分析股骨近端防旋髓内钉(Proximal femoral nail anti-rotation,PFNA)和Gamma在股骨转子间骨折治疗中的应用效果。方法回顾性分析2012年9月至2017年9月本院收治的100例股骨转子间骨折患者的临床资料,根据临床内固定治疗方式不同,将其分为PFNA组和Gamma钉组,各50例,记录两组手术时间、术中出血量及骨折临床愈合时间,比较两组术后12个月的Harris髋关节功能评分,观察并发症发生情况。结果与Gamma钉组比较,PFNA组手术时间较短,术中出血量较少,骨折临床愈合时间较快(均P0.05);PFNA组术后12个月髋关节功能恢复优良率明显高于Gamma钉组(P0.05);PFNA组和Gamma钉组术后并发症发生率比较无明显差异(P0.05)。结论髓内固定方式PFNA及Gamma钉均可有效治疗股骨转子间骨折,但PFNA治疗的效果更为显著,更利于患者预后。     

Gamma3钉与InterTan钉治疗老年股骨转子下骨折的疗效比较

目的比较Gamma3钉与InterTan钉治疗老年股骨转子下骨折的疗效。方法将100例老年股骨转子下骨折患者根据内固定方式分为Gamma3钉组(52例)与InterTan钉组(48例)。比较两组的手术指标、骨折愈合时间、术后髋关节功能恢复情况。结果患者均获得6个月随访。Gamma3钉组的手术时间、手术出血量、X线下透视时间均少于InterTan钉组(P0.001),两组的骨折愈合时间比较差异无统计学意义(P0.05)。术后6个月时两组Harris评分比较差异无统计学意义(P0.05)。术后6个月时髋关节功能优良率:Gamma3钉组为86.54%,InterTan钉组为83.33%,差异无统计学意义(P0.05)。结论 Gamma3钉与InterTan钉内固定治疗老年股骨转子下骨折均能获得较好效果,而Gamma3钉手术创伤更小,更适合手术耐受性差的老年患者。     

The effect of locked distal screws in retrograde nailing of osteoporotic distal femur fractures: a laboratory study using cadaver femurs

OBJECTIVES: To examine the effects of locked distal screws in retrograde nails used in unstable osteopenic distal femur fractures. DESIGN: Biomechanical testing of paired human cadaveric femurs. INTERVENTION: Seven matched pairs of embalmed, moderately osteopenic cadaver femurs were instrumented with 12-mm intramedullary nails in a statically locked, retrograde fashion. One femur of each pair had locked distal screws and the other femur had unlocked distal screws. A 2.5-cm gap of bone was cut nine centimeters from the distal condyles to simulate an unstable fracture. The locked distal screw nails were compared to unlocked distal screw nails for collapse of the fracture gap, medial-lateral and anterior-posterior translation of the nail within the fracture site, and fracture angulation. The femurs were axially loaded, cycled, and then loaded to failure. MAIN OUTCOME MEASURES: Motion at the fracture site with axial cyclic loading and site of failure when loaded to failure. RESULTS: After cycling, both locked distal screw and unlocked distal screw nails demonstrated several millimeters medial and anterior translation within the fracture site and approximately 1 mm collapse of the fracture gap. Although no statistically significant differences were found, the locked distal screw nails had less anterior and medial translation, angulation, and collapse of the fracture gap after cycling. Loads to failure were similar for both locked distal screw and unlocked distal screw nails. It was noted that proximal femur failure occurred at the level of the proximal screw hole in the nail at the subtrochanteric level in 7 (4 locked distal screws and 3 unlocked distal screw groups) of the 14 samples. Four other samples failed through the intertrochanteric region (2 locked distal screw and 2 unlocked distal screw groups) and the remainder within the distal fragment by fracture of the femur along the medial cortex. CONCLUSIONS: Although most differences in fixation stability were not significant, the locked distal screw nails exhibited less fracture collapse and anterior and medial translation of the nail at the fracture site than the unlocked distal screw nails. The degree of varus angulation after cyclic loading was also less for the locked distal screw nails. The length of the nail chosen should avoid having proximal locking screws distal to the lesser trochanter, thus averting proximal femur stress risers and fractures.     

A randomized study of the compression hip screw and Gamma nail in 426 fractures

A prospective, randomized study comparing the compression hip screw with the Gamma nail in the treatment of 426 intertrochanteric fractures is reported. The median patient age was 80 years, and 71% were women The compression hip screw operation took less time except in Evans Type 5 fractures. Blood loss generally was less in the compression hip screw group except in patients with Type 5 fractures. The most frequent surgical problem for patients in the Gamma group was problems with distal locking. Cephalic position of the femoral head screw and cut-out were seen more often in the Gamma nail group. The Gamma nail more frequently preserved the fracture position obtained perioperatively. Whether there was distal locking of the Gamma nail in unstable fractures did not seem to affect the healing rate. Additional fissures or fractures in the proximal femur occurred during five Gamma nail operations and two compression hip screw operations. Postoperative walking ability did not differ between the groups. At 6 months 88% of the fractures were healed. In less comminuted fractures, the compression hip screw method is the preferred method of treatment whereas the Gamma nail is an alternative treatment for more comminuted Evans Type 5 fractures.     

Gamma钉和动力髋螺钉内固定治疗股骨转子间骨折临床疗效比较

目的比较Gamma钉和动力髋螺钉治疗股骨转子间骨折的疗效。方法将100例股骨转子间骨折患者随机分为2组(各50例),分别进行Gamma钉以及DHS治疗,对两组患者住院时间、下床时间以及骨折愈合时间、并发症进行比较。结果住院时间、下床时间、骨折愈合时间:Gamma钉组分别为(12.4±2.3)d、(63.8±4.9)d、(9.8±1.3)d;DHS组分别为(15.6±1.4)d、(84.7±3.9)d、(13.2±2.9)d;两组三方面比较差异均有统计学意义(P<0.05)。按Sahin et al法评定疗效:Gamma钉组优35例,良12例,差3例,优良率94%;DHS组优13例,良27例,差10例,优良率80%;两组比较差异有统计学意义(P<0.05)。并发症比较:Gamma钉组切口感染2例,股骨骨折4例,髋内翻2例,发生率16%;DHS组切口感染3例,股骨骨折3例,髋内翻8例,发生率28%;Gamma钉组髋内翻发生率低于DHS组(P<0.05)。结论 Gamma钉治疗股骨转子间骨折的疗效明显优越于DHS治疗。     

股骨近端锁定钢板内固定治疗老年股骨转子间骨折临床疗效观察

目的 探讨应用股骨近端锁定钢板(locking proximal femul plate,LPFP)内固定治疗老年股骨转子间骨折的临床疗效.方法 回顾性分析比较LPFP治疗老年股骨转子间骨折156例(LPFP组)、动力髋螺钉(dynamic hip screw,DHS)内固定治疗老年股骨转子间骨折42例(DHS组),观察两组手术时间、出血量、住院时间、术后开始负重时间、骨折愈合时间、并发症发生率及Harris评分.结果 所有患者均获随访6.0～24.0个月,平均12.6个月.LPFP组在平均手术时间、出血量、住院时间、术后负重时间、并发症发生率及Harris评分方面优于DHS组,差异有统计学意义(P＜0.05),但骨折平均愈合时间两组差异无统计学意义(P＞0.05).结论 LPFP内固定治疗老年股骨转子间骨折疗效确切,具有创伤小、恢复快、并发症少等优点,值得应用与推广.     

两种方法治疗不稳定性股骨转子间骨折的疗效比较

目的比较股骨近端防旋髓内钉(PFNA)与联合加压交锁髓内钉(InterTan)治疗不稳定性股骨转子间骨折的临床疗效。方法将124例不稳定性股骨转子间骨折患者按照内固定方法分为PFNA组(60例)和InterTan组(64例)。比较两组患者的手术时间、术中出血量、C臂机透视次数、住院时间、骨折愈合时间、术后并发症、术后髋关节功能评分。结果两组患者均获得随访,时间5~22个月。手术时间、术中出血量、C臂机透视次数PFNA组均短(少)于InterTan组(P<0.001)。住院时间、骨折愈合时间及术后髋关节功能评分两组比较差异均无统计学意义(P>0.05)。术后并发症InterTan组少于PFNA组(P<0.05)。结论PFNA手术创伤小,时间短,出血量更少,更适合一般状况差、手术耐受能力差的患者;InterTan稳定性好,术后并发症少,更利于不稳定骨折的固定及术前运动能力好的患者。     

Effect of distal interlocking of a cephalomedullary femoral nail on peri-implant fractures: A sawbone biomechanical analysis

BackgroundA large proportion of hip fractures involve inter-trochanteric fractures which are managed by cephalomedullary nails. There is ongoing debate about the advantages and disadvantages of locked versus unlocked long cephalomedullary femoral nails in the treatment of intertrochanteric fractures. The objectives of our study are to evaluate the biomechanical effects of a distal interlocking bolt on the type of peri-implant fractures in a healed intertrochanteric fracture with long cephalomedullary nail fixation.Methods20 femoral sawbone specimens were prepared with the TFN-ADVANCED Proximal Femoral Nailing System (TFNA) and divided into 2 groups: locked and unlocked. The specimens were subjected to axial loading force until failure. Compressive forces, strain and fracture patterns were compared between the 2 groups.ResultsThere was no significant difference in the mean load to failure of the unlocked specimens compared to locked specimens. However, there was significant difference in the mean compressive stress at the time of failure with the unlocked specimen (1.79±0.17 MPa) compared to the locked group (1.92±0.05 MPa) (p < 0.05). Video review analysis showed unlocked specimens consistently having basi-cervical type peri-implant fractures while locked specimens showed complex, compound fractures of the head-neck region with 2 or more fracture propagation points.ConclusionDistal-locked long cephalomedullary nails in a healed intertrochanteric fracture model are able to tolerate higher compressive stress at the point of failure but demonstrate more complex peri-implant fracture patterns in the femoral head-neck region as compared to unlocked specimens.     

钢板与髓内钉内固定治疗胫骨远端骨折的疗效比较

目的探讨钢板内固定与髓内钉内固定治疗胫骨远端AO-A型骨折的疗效。方法79例患者根据内固定方式分为钢板组(采用锁定解剖钢板内固定,45例)和髓内钉组(采用髓内钉内固定,34例)。比较手术时间、术中出血量、骨折愈合时间、并发症、末次随访时踝关节活动度及Lowa评分。结果患者均获得随访,时间12~28周。手术时间、术中出血量、骨折愈合时间、末次随访时踝关节活动度及Lowa评分髓内钉组均优于钢板组,差异均有统计学意义(P<0.01)。并发症发生例数两组比较差异无统计学意义(P>0.05)。结论钢板内固定与髓内钉内固定治疗胫骨远端AO-A型骨折均有效。髓内钉在AO-A型骨折的治疗中有一定的优势,但需要严格掌握手术适应证。     

INTERTROCHANTERIC FRACTURES OF THE FEMUR: A RANDOMIZED PROSPECTIVE COMPARISON OF THE GAMMA NAIL AND THE AMBl HIP SCREW

Background: The Gamma nail has been introduced as an advance over the Ambi hip screw in intertrochanteric femoral fractures. Its efficacy in an Australasian setting has not been documented. Methods: A prospective randomized study was used to compare the Ambi hip screw and the Gamma nail for the treatment of 69 patients over the age of 50 years with intertrochanteric femoral fractures. The groups were similar with respect to age, sex, prefracture mobility and abode, anaesthetic risk grade, CT measured bone density and fracture pattern. Results: Those treated with the Gamma nail had a significantly longer image intensifier screening time (P <0.05), greater blood loss (P<0.01) and more operative complications. There was no difference in the length of hospital stay but the level of mobility recovered was significantly better in the Ambi group at 6 months follow up. Urine retention was the most frequent complication but did not correlate with the implant or method of anaesthesia. Two implants cut out, one in each group. Limb shortening was similar in both groups and was not affected by leaving the Gamma nail unlocked distally in unstable fractures. Thirteen patients died from pre-existing medical conditions. Conclusions: The Gamma nail proved technically more demanding with higher intra-operative complications and inferior return of mobility.     

带锁髓内钉与锁定加压钢板内固定治疗肱骨干骨折的随机对比研究

目的前瞻性对比研究带锁髓内钉和带锁加压钢板(LCP)治疗肱骨干骨折的临床效果。方法随机将49例分成两组(髓内钉28例;LCP组21例)。患者全部为新鲜肱骨干骨折,骨折部位距肱骨外科颈至少3cm,距尺骨鹰嘴大于5cm。临床疗效评价包括手术时间、出血量、骨折愈合情况、桡神经恢复、感染和肘关节、肩关节不适症状,影像学评价包括骨折力线、愈合时间、延长愈合和不愈合的发生率。结果平均随访1.5年。LCP组19例(90.5)骨折在16周后愈合,髓内钉组24例(85.7)在16周后愈合(P=0.70)。肩关节疼痛和肩关节活动受限在髓内钉组发生明显(P<0.05),而LCP组未发现这种情况。LCP组肘关节的活动范围明显减少(P<0.05),尤其是肱骨干远端1/3骨折患者。两组总并发症发生率比较无明显差异。结论对于需要手术治疗的肱骨干骨折,髓内钉和LCP都能使骨折稳定以达到最终愈合。