Lindsey Ronald W, Ahmed Sonya, Overturf Steven, Tan Alai, Gugala Zbigniew
Department of Orthopedic Surgery & Rehabilitation University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA.
Orthopedics. 2009 Jul;32(7):488. doi: 10.3928/01477447-20090527-15.
The outcome of peritrochanteric fracture fixation is dependent on lag screw placement in the femoral head. The dynamic hip screw technique permits initial, independent lag screw placement, while the cephalomedullary nail dictates its positioning. The objective of this study was to compare the accuracy of lag screw placement for both implant types. A retrospective review of 200 consecutive patients with peritrochanteric fractures stabilized with a dynamic hip screw or cephalomedullary nail was performed. Postoperative biplanar radiographs were used to determine the lag screw tip-apex distance and femoral head zone placement. The study inclusion criteria were met by 137 patients (66 dynamic hip screw; 71 cephalomedullary nail). The patients included 56% women and 44% men with an average age of 73 years. The tip-apex distance and femoral head zone placement demonstrated no statistically significant difference between the 2 implant groups. The lag screw of a cephalomedullary nail was 3.25 times more likely placed in the antero-center zone compared to the dynamic hip screw, and this was statistically significant when compared to other zones. There was a trend toward a more favorable tip-apex distance in women for both implants. The accurate placement of the lag screw can be routinely achieved for both dynamic hip screw and cephalomedullary nail implants, and therefore should not a factor in the selection of these implants for adequate peritrochanteric fracture stabilization. These results represent the immediate postoperative setting, and a follow-up is warranted to establish their long-term clinical relevance.
转子周围骨折固定的结果取决于拉力螺钉在股骨头内的置入位置。动力髋螺钉技术允许最初独立地置入拉力螺钉，而髓内钉则决定了其位置。本研究的目的是比较两种植入物拉力螺钉置入的准确性。对200例采用动力髋螺钉或髓内钉固定转子周围骨折的连续患者进行了回顾性研究。术后使用双平面X线片来确定拉力螺钉尖顶距和股骨头区域位置。137例患者（66例动力髋螺钉；71例髓内钉）符合研究纳入标准。患者包括56%的女性和44%的男性，平均年龄73岁。两种植入物组之间的尖顶距和股骨头区域位置无统计学显著差异。与动力髋螺钉相比，髓内钉的拉力螺钉置于前中心区域的可能性高3.25倍，与其他区域相比具有统计学显著性。两种植入物在女性中尖顶距均有更有利的趋势。对于动力髋螺钉和髓内钉植入物，拉力螺钉的准确置入均可常规实现，因此在选择这些植入物以充分稳定转子周围骨折时不应作为一个考虑因素。这些结果代表了术后即刻情况，有必要进行随访以确定其长期临床相关性。
