McConnell Timothy, Tornetta Paul, Benson Emily, Manuel Jennifer
Boston University Medical Center, MA, USA.
Clin Orthop Relat Res. 2003 Feb(407):199-202. doi: 10.1097/00003086-200302000-00028.
The use of intramedullary hip screws such as the Gamma nail has become a popular option for treatment of proximal femur fractures. The manufacturer recommends that the Gamma nail be inserted at the junction of the anterior (1/3) and posterior (2/3) of the tip of the greater trochanter and on the tip in the same region that the gluteus medius inserts. The purpose of the current cadaveric study was to quantify the damage to the gluteus medius tendon secondary to reaming of the greater trochanter necessary for safe Gamma nail insertion. The gluteus medius was identified and its tendinous insertion was measured. A Kirschner wire was placed in the recommended entry point using the assistance of C-arm fluoroscopy and a 17-mm reamer was advanced over the wire. The tendon then was inspected to evaluate the amount of intrasubstance damage. In 27 of 34 specimens, the portal was contained completely within the tendinous insertion of the gluteus medius. The percentage of the tendon insertion disrupted by the reamer ranged from 14.8% to 52.5% with an average of 27%. During appropriate placement of the Gamma nail, damage to the gluteus medius tendon is unavoidable and should be recognized as a potential cause of postoperative morbidity.
使用髓内髋螺钉，如伽马钉，已成为治疗股骨近端骨折的一种常用选择。制造商建议，伽马钉应插入大转子尖端前（1/3）和后（2/3）的交界处，并在臀中肌附着的同一区域的尖端。本尸体研究的目的是量化为安全插入伽马钉而对大转子进行扩孔时继发的臀中肌腱损伤。识别臀中肌并测量其肌腱附着点。在C形臂荧光透视辅助下，将一根克氏针置于推荐的进针点，并将一根17毫米的扩孔钻沿针推进。然后检查肌腱，评估实质内损伤的程度。在34个标本中的27个中，穿刺孔完全位于臀中肌的肌腱附着处内。扩孔钻破坏的肌腱附着百分比范围为14.8%至52.5%，平均为27%。在正确放置伽马钉的过程中，臀中肌腱损伤不可避免，应被视为术后发病的潜在原因。
