Gamma nail versus locking titanium plate fixation for unstable intertrochanteric fracture in the elderly: hip function

doi:10.3969/j.issn.2095-4344.2015.31.014

Abstract

Abstract:

BACKGROUND: With the diversification of the choice of internal fixation for femoral intertrochanteric fracture, the fixation method for the same kind of fracture can be selected according to surgeon’s habit, and there is no unified standard.
OBJECTIVE: To compare Gamma nail and proximal femoral locking plate fixation for repair of femoral intertrochanteric fractures.
METHODS: A total of 94 elderly patients with unstable intertrochanteric fractures were treated in the Shanxi Armed Police Corps Hospital from April 2009 to September 2012. They were divided into two groups according to fixation methods. Gamma nail group contained 46 cases. Proximal femoral locking plate group contained 48 cases. The two fixation methods were compared and analyzed from the following aspects: incision length, intraoperative bleeding volume, operation time, postoperative hip function recovery, loading time and complications.
RESULTS AND CONCLUSION: Incision length, intraoperative bleeding volume, loading time and complications were better in the Gamma nail group than in the proximal femoral locking plate group (P < 0.05). No significant difference in operation time was detected between the two groups (P > 0.05). The excellent and good rate of hip
function was 96% (44/46) in the Gamma nail group and 92% (44/48) in the proximal femoral locking plate group at 1 year after treatment, and no significant difference was detectable between the two groups (P > 0.05). These findings suggest that Gamma nail and proximal femoral anatomic locking plate for the treatment of unstable intertrochanteric fractures can reach good recovery of hip function, but Gamma nail showed obvious advantages in incision length, intraoperative bleeding volume, loading time and complications.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Femoral Fractures, Internal Fixators, Bone Nails, Follow-Up Studies

CLC Number:

R318

Gao Jin-wei, Chang Jia-nan, Liang Wei-zhi. Gamma nail versus locking titanium plate fixation for unstable intertrochanteric fracture in the elderly: hip function [J]. Chinese Journal of Tissue Engineering Research, 2015, 19(31): 4994-4999.

Figures/Tables 5

References

[1] 张英泽.临床创伤骨折流行病学[M].北京:人民卫生出版社，2009: 155-159.
[2] Zhang YZ.Femoral fractures//Zhang YZ, Chnie M. Epidenfiology of orthopedic trauma.Stuttgart＆New York: Thieme,2012:158-165.
[3] 尹自飞,郑宪有,柴益民,等.新型股骨近端髓内钉与PFN治疗老年股骨转子间骨折的前瞻性比较研究[J].中国骨与关节损伤杂志, 2012,27(2):97-99.
[4] 吴海山.科学审慎对待人工关节置换术治疗股骨转子间骨折[J].中国骨与关节损伤杂志,2009,24(9);769.
[5] Leung KS,Chen CM, So WS,et al.Multicenter trial Of modified Gamma nail in East Asia.Clin Orthop. 1996;323:146-154.
[6] Mahomed N,Harrington I,Kellam J,et al. Biomechanical analysis of the Gamma nail and sliding hip screw. Clin Orthop. 1994;304:280-288.
[7] Nguyen TV,Poeoek N, Eisman JA.Interpretation ofbone mineral density measurement and its change.J Clin Densitom. 2000;3(2):107-119.
[8] 张英泽.下肢骨、关节损伤//陈孝平.外科学[M].8版.北京:人民卫生出版社,2013:680.
[9] Rosenblum SF, Zuckerman JD, Kummer FJ,et al. Abiomechanical evaluation of the Gamma nail. J Bone Joint Surg Br. 1992;74(3):352-357.
[10] Sommers MB, Roth C, Hall H,et al. A laboratory model to evaluate cutout resistance of implants for pertrochanteric fracture fixation.J Orthop Trauma. 2004;18(6):361-368.
[11] 李锋生,叶冬平,梁伟国,等.X线透视导航下运用Gamma钉治疗股骨转子间骨折18例[J].广东医学,2012,33(4):474-476.
[12] 刘云鹏,刘沂,于洪祥,等.骨与关节损伤和疾病的诊断分类及功能评定标准[M].北京:清华大学出版社,2002:71-73.
[13] 刘志雄. 骨科常用诊断分类方法和功能结果评定标准[M].北京:北京科学技术出版社,2005:292-293.
[14] 龚遂良,张中伟,张炳祥,等.Gamma钉治疗老年粗隆部骨折[M].骨与关节损伤杂志,2000,15(1):69.
[15] Haynes RC,Poll RG,Miles AW,et al. Failure of femoral head fixation:a cadaveric analysis of lag screw cut-out with the Gamma locking nail and AO dynamic hip screw.Injury. 1997; 28:337-341.
[16] Miedel R,Ponzer S.Tornkvist H.et al.The standard Gamma nail or the Medoff sliding plate for unstable trochanteric and subtrochanteric fractures. A randomized,controlled trial. J Bone Joint Surg Br. 2005;87:68-75.
[17] 曹磊,纪方.股骨转子间骨折治疗方法进展[J].中国矫形外科杂志, 2008,16(4):276-278.
[18] 齐新文,王进. 股骨近端解剖型钢板治疗股骨转子间骨折[J]. 临床骨科杂志,2006,9(4):376-377.
[19] 汪银魁,邓永发. 解剖型钢板治疗股骨转子间骨折疗效观察[J].中国骨与关节损伤杂志,2006,21(9):757-756.
[20] Sadowski C, Lubbeke A, Saudan M. Treatment of reverse obliqueand transverse intertrochanteric fractures with use of an intramedullary nail. J Bone Joint Surg (Br). 2002;84(3): 372.