第三代Gamma钉微创治疗股骨转子周围骨折  

Treatment of peritroc hanteric fractures with the Gamma 3 nail

作　　者：肖湘[1] 张建国[1] 周连兴[1] 马宝通[1] 张铁良[1] 

机构地区：[1]天津医院创伤骨科, 天津市300211

出　　处：《中华骨科杂志》2008年第4期278-282,共5页Chinese Journal of Orthopaedics

摘　　要：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38．3min（30-70min）。术中平均失血量170ml（100-500m1）。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7．4d（2-23d）。TAD平均值是23．5mm（12．5-36．1mm）。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2．73em（2～3．5cm）。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。Objective To explore the clinical outcome of minimal invasive treatment of peritrochanteric 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 cases and pedestrian injury inl6 cases. 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 Ⅴin 4 cases, grade Ⅳ in 9 cases and grade Ⅲ in 2 cases. 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 locking nail in 3 cases. The median time to partical 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 months （3.2-5.9 months）. The postoperative function was recovered to premorbid 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 point of the main nail. One patient complained the injuried buttock and great trochanter pain. Conclusion Gamma 3 nail can fixed peritrochanteric fractures safely by minimal invasive technique.

关 键 词：髋骨折 骨折固定术 内 内固定器 

分 类 号：R687.3[医药卫生—骨科学]