目的:探讨股骨转子间骨折髓内固定失败的相关因素及其对失败预测的有效性。方法:收集2006年至2010年于我院行闭合复位Gamma钉内固定的股骨转子间骨折患者的临床资料,回顾性分析骨折复位情况、尖顶距(TAD)及拉力螺钉在股骨头颈内的位置3个因素对失败预测的有效性。结果:纳入研究的249例病例,失败共21例,失败率为8.4%。切出组患者平均TAD 35mm,未切出的患者平均TAD 24mm。TAD是一个比较可靠的预测内固定失败的因素。内侧皮质复位情况及是否髋内翻与内固定失败相关。拉力螺钉置于股骨头颈的中下区域能有效防止螺钉切除。结论:闭合复位时尽量复位内侧皮质并避免髋内翻,将拉力螺钉置于股骨头中下区域能有效预防内固定失败,尖顶距能有效预测术后失败风险。

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