Goldhagen P R, O'Connor D R, Schwarze D, Schwartz E
Department of Orthopedic Surgery, Catholic Medical Center of Brooklyn and Queens, Jamaica, NY 11432.
J Orthop Trauma. 1994 Oct;8(5):367-72. doi: 10.1097/00005131-199410000-00001.
Achieving bony union and early weight bearing in peritrochanteric femur fractures poses a continuous challenge for the orthopedic surgeon. Current standards of surgical fixation for the myriad possible fracture patterns include the compression hip screw (CHS), the 90 degrees/95 degrees blade plate, and locked intramedullary nails. The gamma nail (GN) was designed as a "hybrid" of these devices, combining theoretical biomechanical advantages that should allow earlier postoperative weight bearing with surgical technique advantages that should decrease operative morbidity. Because these theoretical advantages were unproven in a clinical setting, we prospectively randomized 75 consecutive patients with peritrochanteric femur fractures into two groups to examine the fixation of these fractures with the GN as compared to the CHS. We found no significant differences in preoperative or intraoperative parameters. Postoperatively, the subtrochanteric fracture group treated with the GN achieved earlier weightbearing status, although this was not statistically significant. 72 patients were available for follow-up at a minimum of 6 months. All fractures had clinically and radiographically healed, and 94% of the patients continued to be ambulatory. Major complications included missed distal locking screws (one patient), cutting out of the lag screw superiorly in the femoral head (two patients), and a femur fracture at the distal end of the GN (one patient). In our series, the GN produced clinical results commensurate with current standards of fixation for peritrochanteric femur fractures. Although the GN allowed earlier independent weightbearing status in patients with subtrochanteric fractures, the procedure was technically more demanding and had a significant learning curve.
在股骨转子周围骨折中实现骨愈合和早期负重，对骨科医生来说一直是一项持续的挑战。针对众多可能的骨折类型，目前的手术固定标准包括加压髋螺钉（CHS）、90度/95度角钢板以及锁定髓内钉。伽马钉（GN）被设计为这些器械的“混合体”，它结合了理论上的生物力学优势，应能使患者术后更早负重，同时具备手术技术优势，应能降低手术发病率。由于这些理论优势在临床环境中尚未得到证实，我们将75例连续的股骨转子周围骨折患者前瞻性地随机分为两组，以研究使用GN与CHS固定这些骨折的情况。我们发现术前或术中参数无显著差异。术后，接受GN治疗的转子下骨折组患者达到了更早的负重状态，尽管这在统计学上并不显著。72例患者至少随访了6个月。所有骨折在临床和影像学上均已愈合，94%的患者仍可行走。主要并发症包括远端锁定螺钉遗漏（1例患者）、拉力螺钉在股骨头上方穿出（2例患者）以及GN远端的股骨骨折（1例患者）。在我们的系列研究中，GN产生的临床结果与目前股骨转子周围骨折的固定标准相当。尽管GN使转子下骨折患者能更早独立负重，但该手术在技术上要求更高，且有明显的学习曲线。
