- 期刊
The Clinical Comparison of Gamma Nail and Compression Hip Screw in the Treatment of Intertrochanteric Fracture
使用Gamma Nail及Compression Hip Screw治療近端股骨骨折之臨床比較
摘要
隨著高年齡層人口及高能量傷害的增加，近端股骨骨折的比例也有逐年遞增的趨勢，本世紀初開始，有各種內固定器被用來治療此類骨折。但傳統的內固定器在強度，穩定度，適應症，手術困難度及併發症方面，有其先天上的缺陷。 Gamma Nail是由一支骨內釘，lag screw，一支set screw，及兩支transverse screws所組成，基本上是Compression hip screw及Interlocking Nail的混合體。因此在生物力學上有應力力臂較短的優點，Lag screw可提供sliding compression的作用以促進骨折的癒合；Transverse Locking screws可固定股骨幹，避免旋轉畸形的發生。此外，閉鎖式的手術方法可縮短手術時間，降低軟組織傷害，並減少感染及輸血的機會。 自1990年六月至十二月止，共有二十例近端股骨折的病例在本院接受Gamma nail手術治療。其中有兩例病人各因腦部轉移癌之併發症及合併之內科疾病於手術後不久死亡，其餘十八例的平均追蹤時間為15.2個月，平均骨折癒合時間為4.1個月，且在接受一年以上追蹤的病例中，皆無延遲癒合或不癒合的現象發生。在併發症方面，有一例病人發生lag screw向股骨頭近端移位：一例病人引發了近端股骨骨折；另一例病人則發生表淺傷口之感染。 我們將追蹤的結果與同時期因相同骨折而用Compression hip screw治療的47位病人結果加以比較，在我們有限的經驗裡，對於Gamma Nail應用在近端股骨骨折之治療效果尚感滿意。相信再經更進一步的臨床證實與長期追蹤，Gamma Nail必可成為治療近端股骨骨折的主要利器。
並列摘要
Twenty patients received operation with Gamma nail for intertrochanteric fracture from june 1990 to Decembel 1990 at Provincial Tao-Yuan Hospital. The average follow-up was 15.2 months. There were two peri-operative mortalities. The average union time was 4.1 months. There were three complications noted post-operatively. One patient sustained proximal migration of lag screw with varus deformity of femoral head. The second patient suffered from ipsilateral femoral shaft fracture and the third patient had superficial wound infection. No non-union, delayed union or mechanical failure was encountered during the period of follow-up. The Gamma nail has the biomechanical advantages of intramedullary nailing, enforced by the two distal locking screws to prevent rotational deformity of the distal fragment. Furthermore, it has those advantages of closed nailing. During the same period, there were forty-seven patients received treatment with compression hip screw. The average union time was 4.5 months and no non- nuion, delayed union or mechanical failure was noted. We compared the results of both groups. We found the Gamma nail might play a more important role in the treatment of intertrochanteric fracture in the future.
並列關鍵字
無資料延伸閱讀
- Chiu, C. H., Wu, C. C., Feng, K. F., Tseng, I. C., Lee, P. C., & Chou, Y. C. (2009). 利用Dynamic Hip Screw治療老人不穩定轉子間骨折：探討Lag Screw在股骨頭中之最佳位置. Journal of Orthopaedic Surgery Taiwan, 26(4), 162-169. https://www.airitilibrary.com/Article/Detail?DocID=10116923-200912-201001150086-201001150086-162-169
- Lee, Y. S., Lo, T. Y., Huang, H. L., Huang, C. R., & Liao, W. Y. (2006). Dynamic Hip Screw對於治療無位移股骨頸骨折之成效. Journal of Orthopaedic Surgery Taiwan, 23(3), 98-104. https://www.airitilibrary.com/Article/Detail?DocID=10116923-200609-23-3-98-104-a
- Lu, Y. C., Huang, C. K., Lo, W. H., Wong, C. Y., Chen, T. S., & Chen, C. M. (1991). 以 Gamma Nail 治療股骨轉子下骨折的早期經驗. Journal of Orthopaedic Surgery Taiwan, 8(1), 17-27. https://www.airitilibrary.com/Article/Detail?DocID=10116923-199103-8-1-17-27-a
- 邱方遙、魯子全、羅惠熙、陳天雄、陳全木、黃清貴（1994）。互鎖式骨髓內釘及Ender氏釘治療脛骨骨折臨床應用之比較。Journal of Orthopaedic Surgery Taiwan，11(1)，47-52。https://www.airitilibrary.com/Article/Detail?DocID=10116923-199403-11-1-47-52-a
- Lin, Y., Tsai, S. C., Wang, H. Y., Lu, Y. Y., & Lin, W. Y. (2010). 骨骼掃描在股骨缺血性壞死接受中心減壓手術合併人工骨移植後的應用－病例討論與相關文獻討論. 核子醫學雜誌, 23(4), 235-240. https://doi.org/10.6332/ANMS.2304.008