Chen Taiyong, Li Kainan, Wang Xuejun, Lan Hai, Zhang Jinjun
Department of Orthopedics, Chengdu Railway Central Hospital, Chengdu Sichuan, 610081, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 Jan;24(1):78-81.
To investigate the reasons of failure of Gamma nail treatment for intertrochanteric fractures and define operative techniques of the revision surgery.
From January 1999 to January 2008, 20 cases of 432 patients treated with Gamma nails for intertrochanteric fractures were revised. There were 9 males and 11 females, aged 24-87 years (median 65 years). Among them, there were 4 cases of femoral shaft fracture, 2 cases of screw penetrating the femoral head, 11 cases of screw cutting out the femoral head and neck, 2 cases of internal rotation malformation, and 1 case of infection. The operative procedures of revision were as follows: 4 cases were treated with the long Gamma nail, 4 cases by adjusting the position of Gamma nail, 11 cases with artificial femoral head replacement, and 1 case by removing Gamma nail and debriding and re-implant the Gamma nail.
The hospitalization days were 16-28 days (21.2 days on average); the bleeding volume during operation was 150-600 mL (380 mL on average). All wounds healed by first intention. Bed rest days were 7-15 days (12.5 days on average). All the patients were followed up for 1-8 years (5 years on average). The operations were successful, the femoral intertrochanteric fracture and femoral shaft fracture reached bony union. Complications such as loosening, breakage of hardware and coxa adduct were not observed. No loosening and dislocation of the prosthesis occurred. Among the patients with complications, 9 patients were treated with a Gamma nail again. Fracture healing was achieved within 2 to 5 months, with an average of 3 months. According to the WANG Fang et al. criterion for hip joint function, the results were excellent in 7 cases and good in 2 cases. In 11 patients who received artificial femoral head replacement, the hip joint function restored to normal. Harris score was 90-93.
Various causes such as osteoporosis, tip-apex distance (> or =25 mm), femoral shaft malformation, Gamma nail shortcomings may lead to complications after Gamma nail treatment for intertrochanteric fractures. Good results will be achieved by different revision techniques.
探讨Gamma钉治疗股骨转子间骨折失败的原因，并明确翻修手术的操作技术。
1999年1月至2008年1月，对432例采用Gamma钉治疗股骨转子间骨折的患者中的20例进行翻修。其中男性9例，女性11例，年龄24 - 87岁（中位年龄65岁）。其中股骨干骨折4例，螺钉穿入股骨头2例，螺钉穿出股骨头颈11例，内旋畸形2例，感染1例。翻修手术操作如下：4例采用加长Gamma钉治疗，4例通过调整Gamma钉位置治疗，11例行人工股骨头置换，1例取出Gamma钉清创后重新植入Gamma钉。
住院天数为16 - 28天（平均21.2天）；术中出血量为150 - 600 mL（平均380 mL）。所有伤口均一期愈合。卧床天数为7 - 15天（平均12.5天）。所有患者均随访1 - 8年（平均5年）。手术成功，股骨转子间骨折和股骨干骨折均达到骨性愈合。未观察到内固定松动、断裂及髋内收等并发症。假体无松动及脱位。并发症患者中，9例再次采用Gamma钉治疗。骨折在2至5个月内愈合，平均3个月。根据王芳等髋关节功能评定标准，优7例，良2例。11例行人工股骨头置换的患者髋关节功能恢复正常。Harris评分90 - 93分。
骨质疏松、尖顶距（≥25 mm）、股骨干畸形、Gamma钉自身缺点等多种原因可导致Gamma钉治疗股骨转子间骨折后出现并发症。采用不同的翻修技术可取得良好效果。
