'E Orthopaedic Department, KAT General Hospital, Athens, Attica, Greece,
Int Orthop. 2014 Jan;38(1):155-61. doi: 10.1007/s00264-013-2196-7. Epub 2013 Dec 7.
The purpose of this prospective randomised trial was to assess whether an intramedullary nail is superior to a sliding hip screw in the treatment of multifragmentary intertrochanteric fractures
Eighty patients with a 31-A2.2 or A2.3 Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) intertrochanteric fracture were randomly allocated to fixation with either the Gamma nail or the AMBI sliding hip screw device.
All patients were followed up at one, three, six and 12 months postoperatively, except for nine who died. There was no statistical difference in Parker mobility score between groups. The Gamma nail group had significantly higher Barthel Index and EuroQol-5D (EQ-5D) scores than the AMBI group at 12 months. At the same time, the EQ-5D score had returned to its pre-operative values in the Gamma nail group but not in the AMBI group. There were no differences in mortality, radiation time and hospital stay. Duration of the operation, incision length and hip pain occurrence were significantly less in the Gamma nail group.
Few failures occur when unstable 31-A2.2 and A2.3 AO/OTA fractures are fixed with a sliding hip screw. Nevertheless, an intramedullary nail seems superior in reconstituting patients to their pre-operative state.
本前瞻性随机试验旨在评估髓内钉与滑动髋螺钉治疗粉碎性股骨转子间骨折的疗效差异。
80 例 31-A2.2 或 A2.3 Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association（AO/OTA）转子间骨折患者被随机分为Gamma 钉固定组和 AMBI 滑动髋螺钉固定组。
除 9 例死亡患者外，所有患者均在术后 1、3、6 和 12 个月进行了随访。两组患者的 Parker 活动评分无统计学差异。Gamma 钉组患者的 Barthel 指数和 EuroQol-5D（EQ-5D）评分在 12 个月时显著高于 AMBI 组。同时，Gamma 钉组的 EQ-5D 评分已恢复到术前水平，而 AMBI 组则未恢复。两组患者在死亡率、射线暴露时间和住院时间方面无差异。Gamma 钉组的手术时间、切口长度和髋部疼痛发生率明显更低。
对于不稳定的 31-A2.2 和 A2.3 AO/OTA 骨折，使用滑动髋螺钉固定很少出现失败。然而，髓内钉在恢复患者术前状态方面似乎更具优势。
