Kukla C, Heinz T, Gaebler C, Heinze G, Vécsei V
Department of Traumatology, University of Vienna Medical School, Vienna, Austria.
J Trauma. 2001 Jul;51(1):77-83. doi: 10.1097/00005373-200107000-00012.
The continuous increase in the number of fractures of the proximal femur is directly attributable to the worldwide increase in life expectancy. The standard version of the Gamma Interlocking-Nail (standard Gamma nail [SGN], 200-mm length, 10-degree valgus curvature, two distal locking bolts) was designed because of the demands in orthopedic hip surgery to develop an implant stable enough to mobilize old patients as soon as possible to avoid further morbidity and mortality.
Between the years 1992 and 1998, 1,000 consecutive patients with peritrochanteric fractures were stabilized by using the SGN and included in this study. Special emphasis was given to the evaluation of the learning curve of the department of traumatology (not of single surgeons) and the influence of prognostic factors on the outcome of such operations.
The results of this study show that increasing "department experience" resulted in a reduction of the intraoperative complication rate by a factor of 0.5 (p = 0.0001) per year. This means that even an inhomogeneous mass of 78 surgeons can lower the rate of intraoperative complications by 50% per year because of increased experience. The number of early postoperative complications annually decreased by a factor of 0.8 (p = 0.0042).
Late postoperative complications correlate negatively with the patient's age (odds ratio, 0.9; p = 0.0001).
股骨近端骨折数量的持续增加直接归因于全球预期寿命的增长。伽马交锁髓内钉的标准版本（标准伽马钉[SGN]，长度200毫米，外翻角10度，两个远端锁定螺栓）是因骨科髋关节手术的需求而设计的，目的是开发一种足够稳定的植入物，以便尽快让老年患者活动，避免进一步的发病和死亡。
在1992年至1998年期间，连续1000例转子周围骨折患者使用SGN进行固定并纳入本研究。特别强调了对创伤科（而非单个外科医生）学习曲线的评估以及预后因素对此类手术结果的影响。
本研究结果表明，“科室经验”的增加使术中并发症发生率每年降低0.5倍（p = 0.0001）。这意味着，即使是由78名外科医生组成的非同质群体，由于经验增加，每年也可将术中并发症发生率降低50%。术后早期并发症的数量每年减少0.8倍（p = 0.0042）。
术后晚期并发症与患者年龄呈负相关（优势比，0.9；p = 0.0001）。
