Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi Road, Suzhou, Jiangsu 215006, China.
Injury. 2010 Dec;41(12):1234-8. doi: 10.1016/j.injury.2010.03.005.
To compare the results between the proximal femoral nail anti-rotation (PFNA) and the third generation gamma nail (TGN) in the treatment of trochanteric fractures.
Between April 2007 and May 2008, 107 consecutive patients older than 60 years with trochanteric femoral fractures were treated with PFNA or TGN. The preoperative variables including patient age, gender, fracture classification, walking ability and American Society of Anaesthesiologists (ASA) rating of operative risk were summarised. Operative time, fluoroscopy time, blood loss, and any intra-operative complication were recorded for each patient. Follow-up was undertaken at 3, 6, and 12 postoperative months, and yearly thereafter. Plain AP and lateral radiographs were obtained at all visits. All changes in the position of the implant, complications, or fixation failure were recorded. Hip range of motion, pain about the hip and the thigh, walking ability score and return to work status were used to compare the outcomes.
There were 55 patients in the PFNA group and 52 in the TGN group. The two groups were comparable with regard to the preoperative variables. The mean follow-up time was 17.5 months (range 12–24). Patients treated with a PFNA experienced a shorter fluoroscopy time and less blood loss. Sixteen patients were lost during the follow-up period. All the other fractures were radiographically healed at the last visit. There were no significant differences between the groups in terms of functional outcomes, hospital stay, intra-operative and postoperative complications.
PFNA provides less blood loss and shorter fluoroscopy time but no advantages in functional outcome, intra-operative and postoperative complications when compared with TGN. These two implants were comparable in the treatment of trochanteric fractures.
比较股骨近端防旋髓内钉（PFNA）和第三代伽马钉（TGN）治疗转子间骨折的效果。
2007 年 4 月至 2008 年 5 月，对 107 例年龄大于 60 岁的转子间骨折患者分别采用 PFNA 或 TGN 治疗。总结患者的术前变量，包括患者年龄、性别、骨折分类、步行能力和美国麻醉医师协会（ASA）手术风险评分。记录每位患者的手术时间、透视时间、失血量和任何术中并发症。术后 3、6、12 个月进行随访，之后每年随访一次。所有患者均在每次就诊时进行骨盆正位和侧位 X 线片检查。记录所有植入物位置变化、并发症或固定失败的情况。采用髋关节活动范围、髋关节和大腿疼痛、步行能力评分和重返工作状态来比较结果。
PFNA 组 55 例，TGN 组 52 例。两组患者的术前变量具有可比性。平均随访时间为 17.5 个月（范围 12～24 个月）。PFNA 组患者的透视时间和失血量较少。随访期间有 16 例患者失访。所有其他骨折在末次随访时均愈合。两组在功能结果、住院时间、术中及术后并发症方面无显著差异。
与 TGN 相比，PFNA 可减少失血量和透视时间，但在功能结果、术中及术后并发症方面没有优势。这两种植入物在治疗转子间骨折方面具有可比性。
