锁定型Gamma钉与改良Gamma钉治疗高龄不稳定型股骨粗隆间骨折的效果比较  

Clinical effects of locking gamma nail versus modified gamma nail for treatment of unstable intertrochanteric femoral fractures in elderly patients

作　　者：张磊 沈杰[2] 黄宰宇 刘丹 何帅 应志豪 吴震东 ZHANG Lei;SHEN Jie;HUANG Zaiyu;LIU Dan;HE Shuai;YING Zhihao;WU Zhendong(Department of Orthopaedics,the 118th Hospital of PLA,Wenzhou 325000,China;Center of Orthopaedics,Southwest Hospital, Third Military Medical University,Chongqing 400038,China;Department of Stomatology,118th Hospital of PLA,Wenzhou 325000,China)

机构地区：[1]解放军第118医院骨科,温州325000 [2]第三军医大学西南医院骨科,重庆400038 [3]解放军第118医院口腔科,温州325000

出　　处：《中华临床医师杂志（电子版）》2017年第16期2115-2119,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：温州市科技计划项目(Y20100220)

摘　　要：目的比较锁定型Gamma钉(LGN)与改良Gamma钉(MGN)治疗高龄股骨粗隆间不稳定型骨折的临床效果。方法回顾性分析解放军第118医院2008年1月至2012年5月143例接受LGN或MGN内固定治疗的高龄股骨粗隆间不稳定型骨折患者的临床资料。其中LGN组67例,MGN组76例,均为不稳定型骨折,对比分析两种手术方法在骨折愈合时间、Harris髋关节功能评分、骨折端压缩程度、颈干角角度变化等方面的差异,其中计量资料采用组间t检验(骨折愈合时间、Harris髋关节功能评分、骨折端压缩程度),计数资料(颈干角角度变化)采用χ2检验。结果患者均获得随访,与MGN组比较,LGN组骨折愈合时间较长[(16.8±7.4)周vs(14.4±6.6)周,P<0.05],但髋关节功能恢复更佳[(86.6±6.3)分vs(83.1±6.7)分,P<0.05],且颈干角角度变化≥10°比例更小(3.0%vs 14.5%,P<0.05),骨折端压缩程度更少[(4.4±2.5)mm vs(7.3±3.1)mm,P<0.05]。结论 LGN和MGN均为治疗高龄股骨粗隆间不稳定型骨折的有效方法,但LGN在防止骨折压缩、塌陷及髋关节功能恢复等方面更具优势。Objective To compare the clinical effects of locking gamma nail(LGN)with modified gamma nail(MGN)in the management of unstable intertrochanteric femoral fractures in elderly patients.Methods A total of143elderly patients with unstable intertrochanteric femoral fractures who were treated with LGN(n=67)or MGN(n=76)at the118th Hospital of PLA from January2008to May2012and had complete clinical data were retrospectively studied.We compare the two groups in terms of fracture healing time,Harris hip score,degree of fracture compression,and variation of Neck shaft angle.Continuous variables(fracture healing time,Harris hip score,and the degree of fracture compression)were compared using the paired t-test,and comparison of categorical variables(the change of Neck shaft angle)was performed using the chi-squared test.Results All of the patients were followed successfully.Compared with the MGN group,the LGN group had significantly longer fracture healing time[(16.8±7.4)weeks vs(14.4±6.6)weeks],less variation of neck-shaft angle(3.0%vs14.5%),lower degree of fracture compression[(4.4±2.5)mm vs(7.3±3.1)mm],and higher Harris hip score[(86.6±6.3)scores vs(83.1±6.7)scores](P<0.05for all).Conclusion Both LGN and MGN are effective in the management of unstable intertrochanteric femoral fractures in elderly patients,but LGN has more advantages in preventing compression of fracture end and recovery of hip joint function compared to MGN.

关 键 词：股骨粗隆间骨折 不稳定型 高龄 锁定型Gamma钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]