Horner Nolan S, Samuelsson Kristian, Solyom Janos, Bjørgul Kristian, Ayeni Olufemi R, Östman Bengt
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
JB JS Open Access. 2017 Sep 25;2(3):e0026. doi: 10.2106/JBJS.OA.17.00026. eCollection 2017 Sep 28.
The purpose of this study was to evaluate the rates of implant-related complications and mortality after treatment of an intertrochanteric or subtrochanteric fracture with a short or long Gamma nail.
Between September 1998 and August 2003, 644 patients at 2 centers treated with a long or short Gamma nail for a hip fracture were prospectively enrolled in this study. These patients were followed until they reached 1 of the study end points, which included death, a reoperation directly related to the Gamma nail, or the end date of the study.
The average age (and standard deviation) of the patients included in the study was 81.3 ± 8.6 years at the time of the operation, and 28.3% of the patients were male. The rate of implant-related complications was 9.9%. The most common complications included peri-implant fracture (4.2%), proximal lateral thigh discomfort requiring extraction of the implant (2.0%), and lag-screw cutout (1.1%). Interestingly, more than half (56%) of the 27 peri-implant fractures occurred >1.5 years after the index operation. The median time from the operation to death was 2.9 years (range, 0 to 17.1 years). The 30-day mortality rate after treatment was 9.5%. Patients with American Society of Anesthesiologists (ASA) class-3 or 4 physical status had a significantly higher risk of mortality than ASA class-1 patients.
Gamma nails are effective in the treatment of intertrochanteric and subtrochanteric fractures. However, 9.8% of patients had complications requiring additional surgery. The most common serious complications include peri-implant fracture and lag-screw cutout. Several peri-implant fractures occurred long after the index procedure. Patients had a high rate of mortality (27%) after 1 year, and higher preoperative ASA class was found to be a predictor of increased risk of mortality. Therefore, clinicians must carefully consider patients' preoperative comorbidities when counselling patients on the risks of surgery.
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在评估使用短或长伽马钉治疗转子间或转子下骨折后与植入物相关的并发症发生率及死亡率。
1998年9月至2003年8月期间，2个中心的644例因髋部骨折接受长或短伽马钉治疗的患者被前瞻性纳入本研究。对这些患者进行随访，直至达到研究终点之一，包括死亡、与伽马钉直接相关的再次手术或研究结束日期。
研究纳入患者手术时的平均年龄（及标准差）为81.3±8.6岁，28.3%为男性。与植入物相关的并发症发生率为9.9%。最常见的并发症包括植入物周围骨折（4.2%）、因大腿近端外侧不适需取出植入物（2.0%）和拉力螺钉穿出（1.1%）。有趣的是，27例植入物周围骨折中超过一半（56%）发生在初次手术后1.5年以上。从手术到死亡的中位时间为2.9年（范围0至17.1年）。治疗后的30天死亡率为9.5%。美国麻醉医师协会（ASA）身体状况分级为3或4级的患者死亡率显著高于ASA 1级患者。
伽马钉在治疗转子间和转子下骨折方面有效。然而，9.8%的患者出现需再次手术的并发症。最常见的严重并发症包括植入物周围骨折和拉力螺钉穿出。数例植入物周围骨折发生在初次手术后很长时间。患者1年后死亡率较高（27%），术前ASA分级较高是死亡风险增加的预测因素。因此，临床医生在向患者告知手术风险时必须仔细考虑患者术前的合并症。
治疗性II级。有关证据水平的完整描述，请参阅作者指南。
