Guyer P, Landolt M, Eberle C, Keller H
Chirurgische Klinik, Stadtspital Triemli, Zürich.
Helv Chir Acta. 1992 Mar;58(5):697-703.
In a prospective randomised trial between September 1989 and June 1990 one hundred patients with per- and subtrochanteric fractures were consecutively treated by gamma-nail or DHS. The average age of both groups was about 80 years. The operation time for gamma-nailing was longer than for DHS implantation and also the postoperative blood loss was higher in the gamma-nail group. We found no difference of intraoperative blood loss, of perioperative lethality and in duration of hospital care. 90% of gamma-nail patients and 80% of DHS patients were successfully able to walk four days after operation with full weight bearing on the operated limb. Three patients in the DHS group with unstable fractures got cranial perforation of the cephalic screw mobilisation. Five patients of the gamma-nail group were reoperated, one case because of missed distal locking, one because of cranial perforation of the cephalic screw after varus dislocation of the proximal fragment. One patient suffered intraoperatively a proximal femur shaft fracture which was corrected during operation. In one case a wound hematoma was evacuated, an other patient needed secondary wound closure. Despite technical imperfection of implant and instruments, we conclude that the gamma-nail allows a very high percentage early and full weight bearing immediately after operation. So we consider that in the treatment of unstable pertrochanteric fractures of geriatric patients, the gamma-nail has proven to be more efficient than the DHS.
在1989年9月至1990年6月进行的一项前瞻性随机试验中，连续100例转子周围和转子下骨折患者接受了伽马钉或动力髋螺钉（DHS）治疗。两组患者的平均年龄均约为80岁。伽马钉固定的手术时间比DHS植入的手术时间长，并且伽马钉组术后失血量也更高。我们发现术中失血量、围手术期死亡率和住院时间没有差异。90%的伽马钉治疗患者和80%的DHS治疗患者在术后四天能够成功行走，患侧肢体完全负重。DHS组中有3例不稳定骨折患者出现了头钉松动导致的颅骨穿孔。伽马钉组有5例患者接受了再次手术，1例是因为远端锁定失败，1例是因为近端骨折内翻移位后头钉颅骨穿孔。1例患者术中发生股骨近端骨折，术中得到了纠正。1例患者进行了伤口血肿清除，另1例患者需要二期伤口缝合。尽管植入物和器械存在技术缺陷，但我们得出结论，伽马钉允许术后早期很高比例的患者立即完全负重。因此，我们认为在老年患者不稳定转子周围骨折的治疗中，伽马钉已被证明比DHS更有效。
