Vidyadhara S, Rao Sharath K
Trauma and Joint Replacement Services, Department of Orthopaedics, KMC Manipal, 576 104 Karnataka, India.
Injury. 2007 Jul;38(7):806-14. doi: 10.1016/j.injury.2006.08.050. Epub 2006 Oct 16.
Intramedullary nailing has been the gold standard in the management of lower limb fractures by virtue of advantage of early joint mobilisation and weight bearing. They are being increasingly used in the peri-trochanteric fractures of femur. Biomechanical studies have proved the supremacy of single femoral neck screw construct over two femoral neck screws along with the intramedullary nails in osteoporotic bones due to lower incidence of complications. This randomised clinical trial was conducted to study the clinico-radiological outcome of single and two-femoral neck screw construct in the management of unstable trochanteric fractures in the elderly osteoporotic bones. Although there was no significant difference in the clinical outcome in the two groups, less sliding of the femoral neck screws was noted with two-femoral neck screw configuration. The tip-apex distance was also significantly lower in the two-screw construct compared to that of the single screw construct. This study to our knowledge is the first randomised control clinical trial evaluating the effectiveness of one and two femoral neck screw configuration of intra-medullary nails in the management of unstable trochanteric fractures.
由于早期关节活动和负重方面的优势，髓内钉固定一直是下肢骨折治疗的金标准。它们在股骨转子周围骨折中的应用越来越多。生物力学研究已经证明，在骨质疏松性骨中，单根股骨颈螺钉结构优于两根股骨颈螺钉与髓内钉联合使用，因为并发症发生率更低。本随机临床试验旨在研究单根和两根股骨颈螺钉结构在治疗老年骨质疏松性骨不稳定转子间骨折时的临床放射学结果。尽管两组的临床结果没有显著差异，但两根股骨颈螺钉结构的股骨颈螺钉滑动较少。与单根螺钉结构相比，两根螺钉结构的尖顶距离也显著更低。据我们所知，这项研究是第一项评估髓内钉单根和两根股骨颈螺钉结构在治疗不稳定转子间骨折有效性的随机对照临床试验。
