Lahoud J C, Asselineau A, Salengro S, Molina V, Bombart M
Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Intercommunal, Villeneuve-Saint-Georges.
Rev Chir Orthop Reparatrice Appar Mot. 1997;83(4):335-42.
Treatment and outcome of sub-trochanteric fractures are at the origin of many problems. The aim of this study was to evaluate the superiority of the "Gamma Nail".
Two homogenous groups of patients were studied. Each group had 40 patients. The osteosynthesis performed in the first group (Group I) was an "angular" type with lateral cortical support (Nail plate, blade plate, dynamic screw). The second group (Group II) received the "Gamma Nail" implant. The 4 criteria employed to compare the 2 groups were: operatory (duration, blood loss, support-free walking); clinical (walking, pain, anatomy); radiological (reduction and healing); and finally complications and failures.
The average operative duration in group I was 3 hrs vs 1 hr in group II. 90 per cent of group I received transfusions with 3 bloods units vs 40 per cent of group II, received 1 blood unit. Support-free walking was authorized 3 months later in group I, and immediately in group II. The results were identical for clinical criteria. The average time for radiological bone healing was 3.5 months in group 1 and 2 months in Group II. 12 complications occurred in group I and 3 in group II: 7 cases of dismantling, 4 non unions and 1 serious deep infection in Group I. In group II: 2 cases of dismantling and a diaphysis fracture beneath the nail. These complications were found in the beginning of our experience with the Gamma Nail.
30 per cent of patients in Group I were affected by complications vs 7.5 per cent in group II (with p = 0.01). The duration of surgery, blood loss, and support-free walking delay demonstrated the superiority of the Gamma nail technique.
This study confirms the superiority of the Gamma nail for the treatment of sub-trochanteric fractures.
股骨转子下骨折的治疗及预后引发了诸多问题。本研究旨在评估“伽马钉”的优势。
对两组同质患者进行研究。每组有40例患者。第一组（I组）采用的骨固定方式为带有外侧皮质支撑的“角形”固定（钉板、刃板、动力螺钉）。第二组（II组）植入“伽马钉”。用于比较两组的4项标准为：手术方面（手术时长、失血量、无需支撑行走情况）；临床方面（行走、疼痛、解剖结构）；放射学方面（复位及愈合情况）；最后是并发症及失败情况。
I组的平均手术时长为3小时，而II组为1小时。I组90%的患者接受了3个单位的输血，而II组40%的患者接受了1个单位的输血。I组在3个月后才允许无需支撑行走，而II组术后即可。临床标准方面的结果相同。I组放射学骨愈合的平均时间为3.5个月，II组为2个月。I组出现了12例并发症，II组出现了3例：I组有7例内固定拆除、4例骨不连和1例严重深部感染。II组有2例内固定拆除和1例钉下骨干骨折。这些并发症出现在我们使用伽马钉经验的初期。
I组30%的患者出现并发症，而II组为7.5%（p = 0.01）。手术时长、失血量和无需支撑行走的延迟均表明伽马钉技术具有优势。
本研究证实了伽马钉在治疗股骨转子下骨折方面的优势。
