推挤大粗隆对粗隆间骨折Gamma钉固定术后颈干角的影响  

Effect of pushing greater trochanter on neck-shaft angle in Gamma nail fixation for intertrochanter fracture

作　　者：段强民[1] 李光磊[1] 常西海[2] 王宝鹏[1] 齐鹏[3] 李栋[3] 

机构地区：[1]滨州医学院附属淄博市临淄区人民医院骨一科,山东淄博255400 [2]滨州医学院附属淄博市临淄区人民医院骨二科,山东淄博255400 [3]滨州医学院附属淄博市临淄区人民医院骨三科,山东淄博255400

出　　处：《中国矫形外科杂志》2014年第22期2034-2039,共6页Orthopedic Journal of China

摘　　要：[目的]探讨粗隆间骨折第3代Gamma钉结合推挤大粗隆对股骨粗隆间骨折术后颈干角的影响。[方法]自2005年12月-20012年8月,采用第3代Gamma钉治疗153例股骨粗隆间骨折患者。试验组77例,在行扩髓、置入主钉时沿垂直骨折线方向对大粗隆采用推挤;对照组76例,采用常规手术操作。依Tronzo-Evens分型,试验组/对照组各型病例数为：Ⅰ型13例/12例,Ⅱ型21例/20例,Ⅲ型23例/26例,Ⅳ型20例/18例。术后采取早期渐进式部分负重功能锻炼。随访观察并对术后早期（2-3 d）,术后3、6、12个月时的颈干角进行测量对比,采用SPSS 13.0通过t检验对测量结果进行对比分析。[结果]术后早期,对照组与试验组间颈干角比较及同型间颈干角比较均无统计学意义（P〉0.05）,而3、6、12个月时试验组总体颈干角间及同型间颈干角显著大于对照组,两组间差异有统计学意义（P〈0.05）。[结论]股骨粗隆间骨折采用第3代Gamma钉固定时,术中对大粗隆采用推挤,可以减少颈干角的丢失。[Objective]To explore the effect of pushing greater trochanter on postoperative neck- shaft angle in intertrochanter fracture using the third generation of Gamma nail. [Method]From December 2005 to August 2012,153 patients,who suffered from intertrochanteirc fracture,were surgically treated using the third generation of Gamma nail（ TGN）. According to manipulations of internal fixation,the patients were divided into the interventional group（ 77 cases） and the control group（ 76cases）. Routine manipulation of TGN was performed in the control group,while additional compressing on the greater trochanter was applied during fracture reduction and insertion of the nails in the interventional group. Postoperatively,all patients taken regular X ray films at the early stage,3,6 and 12 months. Using the SPSS 13. 0 statistical software,the data of neck shaft angle were analyzed by student＇s t test. [Result]Compared with the contorl group,the average data of neck shaft angle and the data based on each type of Tronzo- Evens classification in the interventional group was no significant different immediately after surgery（ P〉0. 05）,while remarkable higher values of neck shaft angle were noted in the interventional group at 3,6 and 12 months（ P〈0. 05） after operation with significantly statistcal differences. [Conclusion]To compress greater trochanter during fracture reduction and insertion of the intramedullary nails could reduce the loss of neck shaft angle in middle term after operation,obtain more reliable fixation using the third generation of Gamma nail.

关 键 词：股骨粗隆间骨折 挤压大粗隆 颈干角 髓内钉 内固定 骨质疏松 

分 类 号：R687.3[医药卫生—骨科学]