Rantanen J, Aro H T
Department of Surgery, University of Turku, Finland.
J Orthop Trauma. 1998 May;12(4):249-52. doi: 10.1097/00005131-199805000-00006.
To compare two implants, the Gamma nail and the intramedullary hip screw (IMHS ), in the treatment of high subtrochanteric femoral fractures.
Prospective, nonrandomized clinical study.
Eighty-seven consecutive patients with high subtrochanteric fractures of the Russell-Taylor Types 1A and 1B were treated with intramedullary fixation. The first fifty patients were treated with the Gamma nail and the next thirty-seven with the IMHS. The results of these operations were evaluated after a minimum follow-up of twelve months, and special emphasis was put on the complication rate.
The number of noninfectious complications (intraoperative fractures, postoperative refractures and fixation failures) was significantly higher (p = 0.037) in the Gamma group (11 of 50, 22 percent) than in the IMHS group (2 of 37, 5 percent). The complication most often associated with the Gamma nail, postoperative fracture of the femoral shaft (six in our Gamma group), was not encountered with the use of the IMHS. The Gamma group also included three cases of intraoperative trochanteric extension of the fracture versus none in the IMHS group. The IMHS group included two mechanical fixation failures.
The lower complication rate associated with the use of the IMHS implant could be attributable in part to the learning curve in the use of intramedullary implants. However, we consider that the evolution of the implant design contributes to the result.
比较Gamma钉和髓内髋螺钉（IMHS）两种植入物在治疗高位转子下股骨骨折中的效果。
前瞻性、非随机临床研究。
连续87例Russell-Taylor 1A和1B型高位转子下骨折患者接受髓内固定治疗。前50例患者采用Gamma钉治疗，后37例采用IMHS治疗。在至少随访12个月后评估这些手术的结果，特别关注并发症发生率。
Gamma组（50例中的11例，22%）的非感染性并发症（术中骨折、术后再骨折和固定失败）数量显著高于IMHS组（37例中的2例，5%）（p = 0.037）。与Gamma钉最常相关的并发症，即股骨干术后骨折（我们的Gamma组中有6例），在使用IMHS时未出现。Gamma组还包括3例骨折术中转子延长，而IMHS组无此情况。IMHS组包括2例机械固定失败。
使用IMHS植入物相关的较低并发症发生率部分可归因于髓内植入物使用中的学习曲线。然而，我们认为植入物设计的改进有助于取得这样的结果。
