Parker Martyn J, Kendrew Jon, Gurusamy Kurinchi
Hip Fracture Project, Peterborough District Hospital, Peterborough, UK.
Hip Int. 2011 Jul-Aug;21(4):393-8. doi: 10.5301/HIP.2011.8578.
Fracture healing complications occur in approximately a third of displaced intracapsular hip fractures treated by reduction and internal fixation. Various radiographic features of the fracture have been used to estimate the risk of fracture healing complications.
To determine which radiographic features of a displaced intracapsular hip fracture were the most reliable in predicting fracture re-displacement after internal fixation.
The pre-operative radiographs for 404 patients with a displaced intracapsular hip fracture treated by reduction and internal fixation were classified using five different variables. These were a direct measurement of trochanteric shortening and fracture shortening, a ratio of fracture displacement, the Garden grade and an alternative interpretation of the Garden grading. Inter-observer reliability of the various classifications was also studied. These observations were related to the later occurrence of fracture displacement or non-union.
Only trochanteric shortening had an acceptable degree of inter-observer variation and this was also the most predictive of fracture re-displacement. The ratio method and fracture shortening were also related to fracture healing complications. Using the traditional Garden grading equal numbers of grade III and IV fractures healed but an alternative interpretation of the Garden grading showed some relationship to the development of non-union.
A direct measurement of shortening of the femur is the most reliable predictor of failure of the fracture to heal.
在通过复位和内固定治疗的移位型髋关节囊内骨折中，约三分之一会出现骨折愈合并发症。骨折的各种影像学特征已被用于评估骨折愈合并发症的风险。
确定移位型髋关节囊内骨折的哪些影像学特征在预测内固定后骨折再移位方面最为可靠。
对404例通过复位和内固定治疗的移位型髋关节囊内骨折患者的术前X线片，使用五个不同变量进行分类。这些变量包括对转子短缩和骨折短缩的直接测量、骨折移位比例、Garden分级以及对Garden分级的另一种解读。还研究了各种分类的观察者间可靠性。这些观察结果与随后发生的骨折移位或不愈合相关。
只有转子短缩具有可接受程度的观察者间差异，并且这也是骨折再移位的最有力预测指标。比例法和骨折短缩也与骨折愈合并发症有关。使用传统的Garden分级，III级和IV级骨折愈合数量相同，但对Garden分级的另一种解读显示与不愈合的发生有一定关系。
对股骨短缩的直接测量是骨折愈合失败最可靠的预测指标。
