A Prospective Study On Gamma Nail To Treat Intertrochanteric Fractures In The Elderly:3-5Years Follow-up

Objective:To investigate the superiority of the medium-term efficacy in treatment of elderly intertrochanteric fracture by Gamma nail. The femoral offset and hip abductor muscle strength were used to assess hip joint function in elderly femoral intertrochanteric fracture with internal fixation, and clinical evaluation of internal fixation effect for elderly intertrochanteric femoral fracture was probably provided new indicator and basis.Methods:From September2001to September2008,420elderly patients who lived permanently in the Chengdu region with intertrochanteric fracture in our hospital were involved in this study, aged60-95years old (average aged75years). All the patients were treated with Gamma nail, dynamic hip screw (DHS) and bone traction according to the principle of voluntary, followed up for3-5years at the out-patient. A total of398patients were followed up more than three years, there were164patients in the Gamma nail group,136patients in the DHS group and98patients in the bone traction group. Gamma nail and DHS groups of patients on perioperative indicators (between injury and surgery time, incision length, operation time, blood loss, hospital stay length),3groups of patients on femoral offset femoral, hip abductor muscle strength,weight loading time, fracture healing time, the excellent and good rate of hip function (Harris score system), complication rate, survival rate, bone mineral density and pain score (VAS score)were analyzed。Results:A total of398patients were followed up for3-5years (average3.5years). There was no significant difference in general data between three groups (P>0.05); Gamma nail and DHS groups were significant difference in incision length, operation time and blood loss (P<0.05). There was significant difference in weight loading time (P<0.05)among the three groups, Gamma nail group was earlier than DHS and bone traction groups(P<0.05). There was significant difference in fracture healing time (P<0.05)among the three groups, Gamma nail group was earlier than DHS and bone traction groups(P<0.05).Three groups of patients were compared after treatment of each time patients with before treatment of bone density change of T value for the difference (P<0.05), there was significant difference (P<0.05)between Gamma nail and DHS groups in addition to1month after treatment, bone traction group was obviously more in amount of bone loss than Gamma nail and DHS groups. There was significant difference in change after treatment of each time patients with the contralateral femoral offset value among the three groups(P<0.05), Gamma nail group was closer to the healthy side than DHS and skeletal traction groups. In addition to the4and5years after treatment, there was significant difference in hip abductor muscle strength among the three groups (P<0.05), Gamma nail group was better in the recovery of hip abductor muscle strength than DHS and bone traction groups. There was significant difference in survival rate, re-fracture rate and complication rate among the three groups(P<0.05), Gamma nail group was higher in survival rate than DHS and bone traction groups, then Gamma nail group was lower in re-fracture and complication rate than DHS and bone traction groups. In addition to1month after treatment, there was significant difference in excellent and good rate of hip function among the three groups (P<0.05), Gamma nail group was higher in excellent and good rate of hip function than DHS and bone traction groups. There was significant difference in pain score among the three groups (P<0.05), after treatment of each time patients of bone traction group were significant difference in pain score between Gamma nail and DHS groups (P<0.05), in addition to6months after treatment there was no significant difference in pain score between Gamma nail and DHS groups (P>0.05).Conclusion:Elderly intertrochanteric fracture should be the preferred minimally invasive internal fixation. The internal fixation of Gamma nail is a good choice for treating elderly femoral intertrochanteric fracture, the wound is smaller, the fixation is more stable, the complication is fewer, the recovery of hip joint function is better, the curative effect is better. The internal fixation of Gamma nail could not be removed and could do functional exercise early after surgery, improve survival and reduce refracture rate. The restoration of femoral offset could promote the recovery of hip abductor muscle strength and hip joint function.