Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China.
Singapore Med J. 2013 Aug;54(8):446-50. doi: 10.11622/smedj.2013152.
Proximal femoral nail antirotation (PFNA) and third-generation Gamma nail (Gamma 3) are widely used in the treatment of intertrochanteric fractures. However, it remains unclear which device achieves better clinical and radiographic outcomes when treating intertrochanteric fractures.
This study comprised 239 patients with intertrochanteric fractures treated with either PFNA or Gamma 3 for a minimum of 12 months. During surgery, the operative time, image intensifier time and amount of blood loss were recorded. Following surgery, we assessed reduction quality and implant position. At the final follow-up, postoperative complications, including femoral shaft fracture, cutout, reoperation, pneumonia, urinary tract infection, cerebral infarction, cardiac infarction and decubital ulcer, were recorded. In addition, walking ability was assessed using the Parker-Palmer mobility score.
No difference was found in the operative time, image intensifier time and amount of blood loss between patients treated with PFNA and those treated with Gamma 3. The reduction quality of fractures treated with Gamma 3 was better than those treated with PFNA. However, there were no significant differences in implant position, walking ability and postoperative complications between the two groups. Although Gamma 3 resulted in better reduction quality, it did not provide any advantages in walking ability and postoperative complications when compared with PFNA.
Therefore, we conclude that both PFNA and Gamma 3 are safe and reliable devices for the treatment of intertrochanteric fractures.
股骨近端防旋髓内钉（PFNA）和第三代伽玛钉（Gamma 3）广泛应用于治疗股骨转子间骨折。然而，对于哪种器械在治疗股骨转子间骨折时能取得更好的临床和影像学结果，目前仍不清楚。
本研究纳入了 239 例至少接受了 12 个月 PFNA 或 Gamma 3 治疗的股骨转子间骨折患者。手术过程中，记录手术时间、X 线透视时间和失血量。手术后，评估复位质量和植入物位置。在最终随访时，记录术后并发症，包括股骨干骨折、切出、再次手术、肺炎、尿路感染、脑梗死、心肌梗死和压疮，同时采用 Parker-Palmer 移动评分评估行走能力。
PFNA 组与 Gamma 3 组患者的手术时间、X 线透视时间和失血量无差异。Gamma 3 治疗的骨折复位质量优于 PFNA 治疗的骨折。然而，两组患者的植入物位置、行走能力和术后并发症无显著差异。尽管 Gamma 3 可获得更好的复位质量，但与 PFNA 相比，在行走能力和术后并发症方面并未显示出优势。
因此，我们认为 PFNA 和 Gamma 3 都是治疗股骨转子间骨折安全可靠的器械。
