Proximal femoral nail for the treatment of reverse obliquity intertrochanteric fractures compared with gamma nail
Proximal femoral nail for the treatment of reverse obliquity intertrochanteric fractures compared with gamma nail
复制标题
DOI：
10.1097/01.ta.0000240455.06842.a0
复制
发表时间：
2007-11-01
影响因子：
--
通讯作者：
Koo, Kyung-Hoi
中科院分区：
文献类型：
--
作者：
Min, Woo-Kie;Kim, Shin-Yoon;Koo, Kyung-Hoi
背景：股骨近端反交型骨折（AO/OTA 31-A3）在力学上不同于大多数转子间骨折。本研究的目的是比较股骨近端髓内钉（PFN）固定与伽马钉（GN）固定这些fracture.Methods的结果：在1993年至2003年，635骨折被归类为转子间或转子下。回顾性分析临床及影像学资料，共发现22例反向骨折。将患者分为两个治疗组，并随访至少1年（范围，12-67个月）。I组11例患者接受PFN治疗，11组11例患者接受GN治疗。两组在人口统计学和损伤变量方面具有可比性。随访时间平均为18个月（范围，12-67个月）。随访期间的影像学变化，临床结果，PFN组和GN组的并发症进行了比较。结果：反向股骨粗隆间骨折占转子间和转子下骨折的4.3%。PFN组平均骨愈合时间为16.5周，GN组为17.9周。PFN组拉力螺钉的平均滑动为2.5 mm，GN组为3.1 mm（p = 0.046）。PFN组颈干角的变化为2.45度，GN组为3.75度（p = 0.032）。PFN组和GN组各有8例患者的功能结局令人满意。PFN组有1例股骨头坏死。GN组中有1例拉力螺钉切出，1例骨不连，1例内翻畸形。结论：PFN组和GN组的临床结局无差异。PFN治疗股骨粗隆间骨折，在生物力学方面优于GN，具有拉力螺钉滑动少、颈干角变化小、并发症少等优点。
Background: The reverse obliquity fracture of the proximal femur (AO/OTA 31-A3) is mechanically different from most intertrochanteric fractures. The purpose of this study was to compare the results of proximal femoral nail (PFN) fixation with those of gamma nail (GN) fixation for these fractures.Methods: Between 1993 and 2003, 635 of the fractures were classified as intertrochanteric or subtrochanteric. Clinical and radiographic records were retrospectively reviewed, and 22 fractures with reverse obliquity pattern were identified. The patients were divided into two treatment groups and were followed up for a minimum of 1 year (range, 12-67 months). Eleven patients in group I were treated with the PFN, and 11 patients in group 11 were treated with the GN. The two groups were comparable with regard to demographic and injury variables. The duration of follow-up averaged 18 months (range, 12-67 months). Radiographic changes during the follow-up, clinical outcome, and complications of the PFN group were compared with those of the GN group.Results: Reverse obliquity intertrochanteric fractures accounted for 4.3% of intertrochanteric and subtrochanteric fractures. Bone union time averaged 16.5 weeks in the PFN group and 17.9 weeks in the GN group. Average sliding of lag screw was 2.5 mm in the PFN group and 3.1 mm in the GN group (p = 0.046). Change of the neck-shaft angle was 2.45 degrees in the PFN group and 3.75 degrees in the GN group (p = 0.032). A satisfactory functional outcome was found in eight patients in the PFN group and also in eight patients in the GN group. There was one osteonecrosis of femoral head in the PFN group. There was one cutting out of lag screw, one nonunion, and one varus deformity in the GN group.Conclusion: There was no difference in clinical outcome between the PFN and GN groups. However, the PFN demonstrated better results biomechanically than the GN did in terms of less sliding of lag screw, less change of neckshaft angle, and less complications for the treatment of reverse obliquity intertrochanteric fractures.