Saarenpää I, Heikkinen T, Jalovaara P
Department of Orthopaedic and Trauma Surgery, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.
Int Orthop. 2007 Feb;31(1):65-70. doi: 10.1007/s00264-006-0088-9. Epub 2006 Apr 22.
The aim of this non-randomised prospective study was to evaluate the short-term outcome of Gamma nail and dynamic hip screw (DHS) fixation in the treatment of subtrochanteric hip fractures due to low-energy trauma in the elderly. All of the 1,624 femoral hip fractures in 1,511 patients of the Oulu Hospital, aged over 49 years, were prospectively registered from 1991-1999 using special forms. Seventy-three (4.5%) of the fractures were subtrochanteric. After exclusions, 58 patients constituted the final study group. Of these, 43 were treated with Gamma nails and 15 with DHS. Background factors before the fracture, complications, reoperations and functional parameters at 4 months were recorded using standardised forms. Intraoperative and hospital data were collected from patient records. The Seinsheimer fracture types IIIA, IIC and V were the most common fracture patterns when the Seinsheimer classification system was used, and Fielding II and AO 31A3.3, respectively, were the most common types in the Fielding and AO classification system. There were four (9%) intraoperative complications in the Gamma nail group as compared to none in the DHS group. On the other hand, postoperative complications were more common in the DHS group (27%) than in the Gamma nail group (7%). We recognised a correlation between certain fracture types and the likelihood of typical intra- or postoperative complications or difficulties with both devices: In Gamma nailing, difficulty in closed reduction as well as the rate of open reduction and the use of supplementary fixation were most frequent in the Seinsheimer IIC fractures. It is also noticeable that all of the postoperative device failures and fracture displacements of the DHS group occurred in the Seinsheimer type IIIA category. Detailed fracture classification is essential for the choice of the fixation device, and the present study confirms the presumption that, despite the perioperative problems associated with Gamma nailing, this technique may be preferable to plate fixation for specific fracture types with medial cortical comminution, such as Seinsheimer type IIIA.
这项非随机前瞻性研究的目的是评估伽马钉和动力髋螺钉（DHS）固定术治疗老年患者低能量创伤所致股骨转子下髋部骨折的短期疗效。1991年至1999年期间，奥卢医院1511例年龄超过49岁患者的1624例股骨髋部骨折均使用特殊表格进行前瞻性登记。其中73例（4.5%）为转子下骨折。排除后，最终研究组有58例患者。其中，43例接受伽马钉治疗，15例接受DHS治疗。使用标准化表格记录骨折前的背景因素、并发症、再次手术情况以及4个月时的功能参数。术中及住院数据从患者病历中收集。采用Seinsheimer分类系统时，IIIA、IIC和V型骨折是最常见的骨折类型，而采用Fielding和AO分类系统时，分别以Fielding II型和AO 31A3.3型最为常见。伽马钉组有4例（9%）术中并发症，而DHS组无术中并发症。另一方面，DHS组术后并发症（27%）比伽马钉组（7%）更常见。我们认识到某些骨折类型与两种固定器械典型的术中或术后并发症或困难的可能性之间存在相关性：在伽马钉固定术中，Seinsheimer IIC型骨折闭合复位困难、切开复位率以及辅助固定的使用率最高。还值得注意的是，DHS组所有术后器械失败和骨折移位均发生在Seinsheimer IIIA型骨折中。详细的骨折分类对于固定器械的选择至关重要，本研究证实了这样一种推测，即尽管伽马钉固定术存在围手术期问题，但对于伴有内侧皮质粉碎的特定骨折类型，如Seinsheimer IIIA型骨折，该技术可能比钢板固定更可取。
