Boriani S, De Iure F, Bettelli G, Specchia L, Bungaro P, Montanari G, Capelli A, Canella P, Regnoli R, Triscari C
1a. Clinica Ortopedica, Ist. Rizzoli, Bologna.
Chir Organi Mov. 1994 Apr-Jun;79(2):193-203.
A total of 1147 pertrochanteric and subtrochanteric fractures, 10 delays in consolidation and non-union, 24 pathologic fractures and osteolysis with the risk of fracture, treated with a gamma nail in 17 Italian departments of traumatology, were collected. In 70% of the patients weight-bearing was allowed during the first week postsurgery; 77% of the patients followed-up recovered the same ability to walk that had preceded trauma. Complications included intraoperative (1.8%) and postoperative (1.1%) diaphyseal fractures, cephalic screw cut out (2.2%), and breakage of the nail (0.4%). There were two cases of infection (0.3%). Most of the complications were related to errors in technique. The safest procedure is constituted by the choice of a nail with a thinner caliber, 2 mm diaphyseal over-reaming, insertion of the nail without the use of a hammer, and distal locking; the cephalic screw must always be inserted in the lower portion of the femoral head.
收集了意大利17个创伤科用伽马钉治疗的1147例转子周围和转子下骨折、10例骨愈合延迟和骨不连、24例病理性骨折以及有骨折风险的骨质溶解病例。70%的患者在术后第一周即可负重；77%接受随访的患者恢复了受伤前的行走能力。并发症包括术中（1.8%）和术后（1.1%）骨干骨折、股骨头螺钉穿出（2.2%）以及髓内钉断裂（0.4%）。有2例感染（0.3%）。大多数并发症与技术失误有关。最安全的操作包括选择直径较细的髓内钉、骨干扩髓2 mm、不使用锤子插入髓内钉以及远端锁定；股骨头螺钉必须始终插入股骨头下部。
