- 期刊
Gamma Nailing for Subtrochanteric Fractures - A Preliminary Report
以 Gamma Nail 治療股骨轉子下骨折的早期經驗
摘要
股骨轉子下骨折的治療對骨科醫師來說，一直是很大的挑戰，因為此處為應力集中區域，且在肌肉相對作用下，骨斷端通常遠離，故選擇內固定哭對於治療的成功與否，佔了很重要的角色。 Gamma Nail在構造上是屬於骨內釘，其應力力臂較compression hip screw短，且兼具了compression hip screw 的最大優點……sliding compression機轉，Gamma Nail設計上有兩股骨遠端鋼釘，可將骨折遠端固定得更牢，另外，Gamma Nail的手術是採閉鎖式復位，對骨折的癒合較好，且較少軟組織的破壞及出血本院自民國78年9月起，開始以Gamma Nail治療股骨轉子下骨折，我們追縱最早的七位病人，平均追縱時間9.3個月，其中一位病中在術後第七周因肝硬化併發食道靜脈曲張破裂而死亡，其餘六位平均癒合時間為18.3周，沒有延遲癒合，不癒合或內固定器斷裂的現象發生，這六位病人最後都回復到術前的情況。有一個病人例在癒合過程中發生股骨頭內lag screw向近端移動，同時合併髖內翻的併發症，其餘五位最後癒合的位置，與術後的復位差不多。 以本院對於Gamma Nail應用在股骨轉子骨折的早期經驗，我們對於初步成果尚覺滿意，認為它可能是種不錯的設計，尤其對於活動量大的年輕人。但尚待進一步的臨床證實。
關鍵字
無資料並列摘要
Abstract: From September 1989 to February 1990, seven patients with subtrochanteric and intertrochanteric fractures were treated with Gamma nail fixation. The average follow-up is 9.3 months. One patient died of poor medical condition seven weeks after operation. There were no delayed union, nonunion or mechanical failure. Osseous union occurred in a mean time of 18.3 weeks of the other six patients. Proximal migration of the lag screw together with varus deformity of the femoral head was noted in one patient, while the other five healed as the original reduction pattern except sliding – compression mechanism. All of the six patients regained their pre- operaitve status. The Gamma nail has the biomechanical advantages of intramedullary rod and compression hip screw. The two distal locking screws provide more rotational stability for the distal fragment, while close nailing and the administration of target device help in minimal soft tissue dissection and decreased roentgen exposure. In our early limited experience of Gamma nailing, we found it may be a good alternative for treatment of subtrochanteric fractures, especially in the young men.
延伸閱讀
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- Lee, Y. S., Lo, T. Y., & Huang, H. L. (2006). 年長病人的非位移性股骨頸骨折之內固定法：Dynamic Hip Screw與Cannulated Screw的比較. 北市醫學雜誌, 3(7), 673-682. https://doi.org/10.6200/TCMJ.2006.3.7.04
- Lee, Y. H., Lee, Y. C., & Peng, M. C. (2021). 同時雙側股骨頸骨折以一階段半髖人工關節治療：病例報告與文獻探討. 輔仁醫學期刊, 19(1), 30-37. https://doi.org/10.3966/181020932021031901004