[Comparison of effects between two operating methods of treating intertrochanteric hip fracture with Gamma nail fixation].

OBJECTIVE: To evaluate the surgical efficiency of treating the intertrochanteric hip fracture with the Gamma nail fixation and to compare two operating methods of the Gamma nail fixation.

METHODS: From August 2000 to August 2006, 69 patients (32 males, 37 females; age, 43-98 years;average, 72.3 years) with the intertrochanteric hip fracture but with no associated injury were treated with the Gamma nail fixation. The patients' average illness course was 5. 6 days (range, 3-14 days). Among the 69 patients, 36 were treated with the traditional method of the Gamma nail fixation (Group A) and 33 were treated with an improved method of the Gamma nail fixation (Group B). According to the Association for the Study of Internal Fixation (AO-ASIF) classification, in Group A, 5 patients had a disease of Type A1, 23 of Type A2, and 8 of Type A3; in Group B, 8 patients had a disease of Type A1, 21 of Type A2, and 4 of Type A3. The data from the two groups were analyzed, and the statistical analysis was made on the following aspects: incision length, operating time, intraoperative bleeding, X-ray exposure frequency, drainage amount, blood transfusion volume, postoperative infection of the lungs, superficial infection of the incision, duration of antibiotic use, standing with the walking stick after operation, complication due to internal fixation, healing time for the fracture, and the hip function recovery half a year after operation assessed with the Harris scoring system.

RESULTS: All the 69 patients were followed up for 8-80 months (average, 42 months). We studied the indexes such as incision length, operating time, intraoperative bleeding, X-ray exposure frequency, drainage amount, and blood transfusion volum; above indexes in Group A were 9.5 +/- 4.7 cm, 85 +/- 35 min, 186.0 +/- 87.3 ml, 9.0 +/- 5.1 times, 102.7 +/- 49.8 ml, 325.0 +/- 169.5 ml; and those were 5.3 +/- 1.2 cm, 46 +/- 10 min, 65.0 +/- 26.0 ml, 3.0 +/- 2.1 times, 52.5 +/- 16.2 ml, 203.0 +/- 61.2 ml in Group B. The above indexes showed that the surgical efficiency in Group B was significantly better than that in Group A (P < 0. 05). The postoperative recovery indexes such as infection of the lungs, infection of the incision, duration of antibiotic use, standing time after operation, union time of fracture, and function score, were studied. There was a statistically significiant difference in lung infection, incision infection, duration of antibiotic use, and standing time after operation between Group A and Group B (P < 0.05).

CONCLUSION: The improved method of the Gamma nail fixation for treating the intertrochanteric hip fracture can increase the surgical efficiency and improve the patient's early recovery after operation, especially suitable for the elderly patients who have more complications. This kind of method can shorten the operating time and the anesthesia duration, reducing the incision infection and the blood loss during operation, and decrease the frequency of the X-ray use.