Jiang Lei-Sheng, Shen Lei, Dai Li-Yang
Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Ann Acad Med Singap. 2007 Oct;36(10):821-6.
The objective of this study was to prospectively evaluate the clinical outcome of traumatic subtrochanteric fractures fixed with long proximal femoral nail (PFN) or long gamma nail with particular emphasis on our experience of surgical techniques.
We reviewed the results of 49 consecutive patients who had undergone intramedullary fixation specifically with a long PFN or a long gamma nail for traumatic subtrochanteric fractures in our hospital during a 2-year period from January 2003 to December 2004. The average age of the patients was 53 years. Clinical and radiographic analyses were performed when follow-up was made at 6 weeks, 12 weeks, 6 months, 1 year and 2 years.
All the 49 traumatic subtrochanteric fractures healed uneventfully except 1 case of delayed union. Walking and squatting ability was completely restored in every case at follow-up examination 6 months postoperatively. Among them, 32 fractures were successfully reduced with traction on a fracture table under fluoroscopy, but cerclage wiring or cable bandage through a small incision was needed in the other 17 cases. The average operative time was 46 minutes (range, 21 to 98). Eighteen Seinsheimer type II fractures were left unlocked distally, and static distal interlocking with 1 bolt was carried out in the other 31 cases. No complications such as cutout or breakage of the implants were encountered.
This study suggests that long PFN or long gamma nail is a reliable implant for subtrochanteric fractures, leading to high rate of bone union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages, but the operation is technically demanding. Gradual learning and great patience is needed in order to make this method truly minimally invasive.
本研究的目的是前瞻性评估采用股骨近端加长髓内钉（PFN）或加长伽马钉固定创伤性股骨转子下骨折的临床疗效，尤其着重于我们的手术技术经验。
我们回顾了2003年1月至2004年12月期间在我院连续接受采用加长PFN或加长伽马钉进行髓内固定治疗创伤性股骨转子下骨折的49例患者的结果。患者的平均年龄为53岁。在术后6周、12周、6个月、1年和2年进行随访时进行临床和影像学分析。
49例创伤性股骨转子下骨折除1例延迟愈合外均顺利愈合。术后6个月随访检查时，每例患者的行走和下蹲能力均完全恢复。其中，32例骨折在透视下通过骨折牵引床成功复位，但另外17例需要通过小切口进行环扎钢丝或缆带固定。平均手术时间为46分钟（范围为21至98分钟）。18例Seinsheimer II型骨折远端未锁定，另外31例采用1枚螺栓进行静态远端交锁。未遇到诸如植入物穿出或断裂等并发症。
本研究表明，加长PFN或加长伽马钉是治疗股骨转子下骨折的可靠植入物，可实现高骨愈合率并使软组织损伤最小化。髓内固定具有生物学和生物力学优势，但手术技术要求较高。为使该方法真正实现微创，需要逐步学习并具备极大的耐心。
