A RANDOMISED PROSPECTIVE COMPARISON OF THE GAMMA NAIL AND THE DYNAMIC HIP SCREW
A RANDOMISED PROSPECTIVE COMPARISON OF THE GAMMA NAIL AND THE DYNAMIC HIP SCREW
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发表时间：
1991
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通讯作者：
S. H. Bridle;A. Patel;M. Bircher;P. Calvert
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作者：
S. H. Bridle;A. Patel;M. Bircher;P. Calvert
我们前瞻性地比较了随机使用动力髋螺钉（DHS）或新型髓内器械Gamma钉固定100例老年患者股骨近端转子间骨折的效果。我们发现在手术时间、失血量、伤口并发症、住院时间、最终出院地点或患者最终复查时的活动性方面没有差异。近端固定失败没有差异：DHS有3例发生切出，Gamma髓内钉有2例。然而，在4例病例中，股骨骨折发生在Gamma髓内钉附近，需要进一步大手术。在没有这些并发症的情况下，两组均在6个月内观察到愈合。在英国，股骨粗隆间骨折内固定的常用器械是某种形式的滑动髋螺钉。这已被证明比诸如朱厄特钉板的单件式装置产生更好的结果（詹森，T#{248}ndevold和Mossing 1978;班尼斯特和吉布森1983 ; Esser，卡萨布和Jones 1986）。然而，并发症很常见;据报道，10%-20%的病例固定失败（Wolfgang，Bryant and奥尼尔1982;纳恩1988; Simpson，Varty and Dodd 1989）。主要问题是股骨头切出;也发生了接骨板断裂、轴杆脱落和部件脱离。植入物失效与骨折类型有关，尤其是其稳定性;与复位不充分、骨质疏松和螺钉在股骨头内的位置不准确有关（Mulholland和古恩，1972; Wolfgang等，1982; Davis等，1990）。Gamma髓内钉（Howmedica UK，Park皇家，伦敦）是一种新器械，将髓内固定在骨干中与近端骨折块中的螺钉结合在一起
We have prospectively compared the fixation of 100 intertrochanteric fractures of the proximal femur in elderly patients with random use of either a Dynamic Hip Screw (DHS) or a new intramedullary device, the Gamma nail. We found no difference in operating time, blood loss, wound complications, stay in hospital, place of eventual discharge, or the patients’ mobility at final review. There was no difference in failure of proximal fixation: cut-out occurred in three cases with the DHS, and twice with the Gamma nail. However, in four cases fracture of the femur occurred close to the Gamma nail, requiring further major surgery. In the absence of these complications, union was seen by six months in both groups. In the United Kingdom, the usual device for internal fixation of intertrochanteric fractures of the femur is some form of sliding hip screw. This has been shown to produce better results than one-piece devices such as the Jewett nail plate (Jensen, T#{248}ndevold and Mossing 1978; Bannister and Gibson 1983 ; Esser, Kassab and Jones 1986). However, complications are frequent; failure of fixation has been reported in 10% to 20% of cases (Wolfgang, Bryant and O’Neill 1982; Nunn 1988; Simpson, Varty and Dodd 1989). The main problem has been cutting out of the femoral head ; plate breakage, pulling off the shaft, and disengagement of the components have also occurred. Implant failure has been related to type of fracture, particularly its stability ; and to inadequate reduction, osteoporosis, and inexact placement of the screw within the femoral head (Mulholland and Gunn 1972; Wolfgang et al 1982; Davis et al 1990). The Gamma nail (Howmedica UK, Park Royal, London) is a new device, combining intramedullary fixation in the shaft with a screw in the proximal fragment