Kang Joon Soon, Kwon Yong Tak, Suh Young Ju, Lee Tong Joo, Ryu Dong Jin
Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Republic of Korea.
Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, South Korea.
Geriatr Orthop Surg Rehabil. 2020 Dec 13;11:2151459320979975. doi: 10.1177/2151459320979975. eCollection 2020.
Unstable trochanteric femur fractures in elderly patients with osteoporosis are still challenging. Gamma3 nail with the U-blade lag screw (U-blade gamma nail) has been developed to improve mechanical stability of proximal femoral fragment. This study aimed to compare the clinical and radiologic outcomes of U-blade gamma nail to proximal femoral nail antirotation (PFNA), and standard Gamma3 nail (gamma nail) for unstable trochanteric femur fractures.
A retrospective matched-pair case study was performed with U-blade gamma nail, PFNA, and gamma nail. During 2012-2018, 970 patients with unstable trochanteric femur fractures were reviewed. Matching criteria were set as follows: 1) sex; 2) age (± 3 years); 3) body mass index (± 2 kg/m); 4) bone mineral density (± 1 T-score in femur neck). Finally, a total of 159 patients were enrolled. We assessed the tip-apex distance (TAD), neck shaft angle, and hip screw sliding distance using plain radiographs. Also, we evaluated the clinical outcomes with Koval's grade and fixation failure during 2 years.
The mean postoperative TAD was not significantly different among the 3 groups (p = 0.519). However, the change in the TAD at 1 year (p = 0.027) and 2 years (p = 0.008) after surgery was significantly smaller in U-blade gamma nail group compared with PFNA and gamma nail group. The hip screw sliding distance at 1 year (p = 0.004) and 2 years (p = 0.001) after surgery was significantly smaller in U-blade gamma nail group compared with PFNA and gamma nail group. However, there was no significant difference of Koval's grade and fixation failure among the 3 groups (p = 0.535).
U-blade gamma nail showed favorable radiologic results in terms of the change in the hip screw position. However, U-blade gamma nail was not superior to PFNA and gamma nail in clinical outcomes.
骨质疏松老年患者的不稳定型股骨转子间骨折仍然具有挑战性。已研发出带U型刀片拉力螺钉的Gamma3钉（U型刀片Gamma钉），以提高股骨近端骨折块的机械稳定性。本研究旨在比较U型刀片Gamma钉与股骨近端抗旋髓内钉（PFNA）及标准Gamma3钉（Gamma钉）治疗不稳定型股骨转子间骨折的临床和影像学结果。
采用回顾性配对病例研究，纳入使用U型刀片Gamma钉、PFNA及Gamma钉的患者。2012年至2018年期间，对970例不稳定型股骨转子间骨折患者进行了回顾性分析。匹配标准如下：1）性别；2）年龄（±3岁）；3）体重指数（±2kg/m²）；4）骨密度（股骨颈T值±1）。最终，共纳入159例患者。我们使用X线平片评估尖顶距（TAD）、颈干角和髋螺钉滑动距离。此外，我们采用Koval分级和2年内的内固定失败情况评估临床结果。
三组术后平均TAD差异无统计学意义（p = 0.519）。然而，与PFNA组和Gamma钉组相比，U型刀片Gamma钉组术后1年（p = 0.027）和2年（p = 0.008）时TAD的变化明显更小。与PFNA组和Gamma钉组相比，U型刀片Gamma钉组术后1年（p = 0.004）和2年（p = 0.001）时髋螺钉滑动距离明显更小。然而，三组间Koval分级和内固定失败情况差异无统计学意义（p = 0.535）。
就髋螺钉位置变化而言，U型刀片Gamma钉显示出良好的影像学结果。然而，U型刀片Gamma钉在临床结果方面并不优于PFNA和Gamma钉。
