【摘要】 目的比较经典和改良的两种Gamma钉植入方法,为进一步提高手术效率,改善疗效。方法2000年8月~2006年8月收治69例股骨转子间骨折患者,男32例,女37例;年龄43~98岁,平均72.3岁。病程3~14d,平均5.6d,无合并伤。经典Gamma钉手术组为A组36例,改良Gamma钉手术组为B组33例。参照AO股骨转子间骨折分型标准,A组A1型5例,A2型23例,A3型8例;B组A1型8例,A2型21例,A3型4例。对两组的手术时间、切口长度、出血量、X线暴露次数、引流量及输血量,以及术后肺部感染、切口浅层感染、抗生素使用时间、下床时间、骨折愈合时间,半年后患髋功能Harris评分进行准确记录并作统计分析。结果69例均获随访8个月~6年8个月,平均3年6个月。随访1年内无死亡。两组手术切口长度、手术时间、术中出血量、X线透视次数、术后引流量及输血量,A组分别为9.5±4.7cm,85±35min,186.0±87.3ml,9.0±5.1次,102.7±49.8ml,325.0±169.5ml;B组分别为5.3±1.2cm,46±10min,65.0±26.0ml,3.0±2.1次,52.5±16.2ml,203.0±61.2ml;经比较差异均有统计学意义(P<0.05)。术后康复资料显示,肺部感染和切口浅层感染发病率、抗生素使用时间、术后下床时间,B组均优于A组,比较差异有统计学意义(P<0.05)。骨折临床愈合时间、术后髋关节功能恢复两组比较无统计学意义(P>0.05)。结论改进Gamma钉植入方法,可以提高股骨转子间骨折手术效率,改善术后早期恢复的效果,尤其对合并症较多的老年患者,缩短手术和麻醉时间,减少创伤和失血,以及X线暴露次数,更有利于术后早期恢复。更多还原

【Abstract】 Objective To evaluate the surgical efficiency of treating the intertrochanteric hip fracture with the Gamma nail fixation and to compare two operating methods of the Gamma nail fixation. Methods From August 2000 to August 2006, 69 patients (32 males, 37 females; age, 43-98 years;average, 72.3 years) with the intertrochanteric hip fracture but with no associated injury were treated with the Gamma nail fixation. The patients’ average illness course was 5.6 days (range, 3-14 days). Among the 69 patients, 36 were treated with the traditional method of the Gamma nail fixation (Group A) and 33 were treated with an improved method of the Gamma nail fixation (Group B). According to the Association for the Study of Internal Fixation (AO-ASIF) classification, in Group A, 5 patients had a disease of Type A1, 23 of Type A2, and 8 of Type A3; in Group B, 8 patients had a disease of Type A1, 21 of Type A2, and 4 of Type A3. The data from the two groups were analyzed, and the statistical analysis was made on the following aspects: incision length, operating time, intraoperative bleeding, X-ray exposure frequency, drainage amount, blood transfusion volume, postoperative infection of the lungs, superficial infection of the incision, duration of antibiotic use, standing with the walking stick after operation, complication due to internal fixation, healing time for the fracture, and the hip function recovery half a year after operation assessed with the Harris scoring system. Results All the 69 patients were followed up for 8-80 months(average, 42 months). We studied the indexes such as incision length, operating time, intraoperative bleeding, X-ray exposure frequency, drainage amount, and blood transfusion volum; above indexes in Group A were 9.5±4.7 cm, 85±35 min, 186.0±87.3 ml, 9.0±5.1 times, 102.7±49.8 ml, 325.0±169.5 ml; and those were 5.3±1.2 cm,46±10 min, 65.0±26.0 ml,3.0±2.1 times,52.5±16.2 ml,203.0± 61.2 ml in Group B. The above indexes showed that the surgical efficiency in Group B was significantly better than that in Group A (P<0.05). The postoperative recovery indexes such as infection of the lungs, infection of the incision, duration of antibiotic use, standing time after operation, union time of fracture, and function score, were studied. There was a statistically significiant difference in lung infection, incision infection, duration of antibiotic use, and standing time after operation between Group A and Group B(P<0.05). Conclusion The improved method of the Gamma nail fixation for treating the intertrochanteric hip fracture can increase the surgical efficiency and improve the patient’s early recovery after operation, especially suitable for the elderly patients who have more complications. This kind of method can shorten the operating time and the anesthesia duration, reducing the incision infection and the blood loss during operation, and decrease the frequency of the X-ray use.更多还原