Subtrochanteric Femoral Fractures Treated By Reverse Less Invasive Stabilization System, Dynamic Condylar Screw And Gamma Nail: A Clinical Comparative Study

Objective:To explore the clinical effects of subtrochanteric femoral fractures treated by reverseless invasive stabilization system, dynamic condylar screw and gamma nail.Methods:From August2007to August2013，90patients with subtrochanteric femoral fracturewere admitted to our hospital. They were treated by reverse less invasive stabilizationsystem (LISS group), dynamic condylar screw (DCS group) and gamma nail (GN group),respectively. The LISS group included30cases, DCS group included28cases and GNincluded32cases. Every patient underwent skin traction or tibial tubercle tractions beforethe operation. Hip anteroposterior radiograph, CT examination of proximal part of thefemur and three-dimensional reconstruction were applied for the patients. Theaccompanying diseases were also treated actively. The patients were follow-up regularlypost-operation. And we recorded the operation time, blood loss, x-ray exposure times,preoperative and postoperative D-value of haemoglobin, the incidence rate ofpostoperative complications, average fracture healing time and Harris hip score of3months and12months after operation. The data was analyzed by Stata11.0and SPSS19.0software.Results:All the patients were followed up after internal fixation. The follow-up time was from12to23months, and the mean time was15.3months. The study reveals that no obviousdifference in operation time and fracture healing time between the three groups (P>0.05).The blood loss and preoperative and postoperative D-value of haemoglobin of DCS groupwere more than that of the LISS and GN Groups (P<0.05), and the x-ray exposure times isless than them (P<0.05). The incidence rate of postoperative complications of GN group is significantly lower than that of the LISS and DCS groups (P<0.05). The GN group wassignificantly better than the LISS and DCS Groups on the early period (3months) activityfunction recovery of hip joints (P<0.05), but there was no significant difference on that12months later between the three groups (P>0.05).Conclusion:1、It can acquire satisfactory effects when subtrochanteric femoral fractures treated byreverse LISS, DCS and GN.2、 Compared to DCS, reverse LISS and GN have thecharacteristics of less tissue injury and blood loss. GN, which has better early periodactivity function recovery of hip joints and lower incidence rate of postoperativecomplications, can be used as the first choice for subtrochanteric femoral fractures.