Department of Trauma & Orthopaedics, Nottingham University Hospital, Queens Medical Centre, Nottingham NG7 2UH, UK.
Injury. 2012 Jun;43(6):817-21. doi: 10.1016/j.injury.2011.09.011. Epub 2011 Oct 29.
Recent studies have recommended the use of cephalo-medullary devices for the treatment of reverse oblique intertrochanteric femoral fractures (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen, OTA/AO 31-A3). Both the proximal femoral nail (PFN) and the gamma nail (GN) have shown good outcome results but the results of treatment with the intramedullary hip screw (IMHS) have not been reported in the literature. Our aim was to review the outcomes of these unstable fractures treated with the IMHS implant at our institute.
Between 1999 and 2008, 6724 consecutive hip fractures were treated at our institute. There were 115 reverse oblique intertrochanteric fractures and 63 of these were treated with the IMHS. We retrospectively reviewed clinical and radiological records for these fractures treated with the IMHS. Follow-up duration ranged from 1 to 6 years.
Amongst the 63 patients treated with the IMHS, 57 (90.5%) fractures were reduced satisfactorily with one poorly positioned hip screw and one breach of the anterior femoral cortex. The mean operative time was 115 min, 22 patients required a blood transfusion and 20 had postoperative medical complications. The major orthopaedic complications included two cases of malrotation, three nonunions and one traumatic periprosthetic fracture with a total failure rate of 7.9%. There were four cases of distal locking bolts breaking or backing out. The 30-day mortality was 6.5%.
The clinical and radiological outcomes achieved with the IMHS compare favourably to the results achieved with other cephalo-medullary devices. We consider the long IMHS a good implant for the treatment of these unstable fractures.
最近的研究建议使用头髓内装置治疗反向斜型股骨转子间骨折（骨科创伤协会/骨固定学会，OTA/AO 31-A3）。股骨近端髓内钉（PFN）和伽玛钉（GN）均显示出良好的结果，但髓内髋螺钉（IMHS）治疗的结果尚未在文献中报道。我们的目的是回顾在我们机构使用 IMHS 植入物治疗这些不稳定骨折的结果。
1999 年至 2008 年，我们机构共治疗了 6724 例连续髋部骨折。其中有 115 例反向斜型股骨转子间骨折，其中 63 例采用 IMHS 治疗。我们回顾性地审查了采用 IMHS 治疗的这些骨折的临床和影像学记录。随访时间从 1 年到 6 年不等。
在采用 IMHS 治疗的 63 例患者中，57 例（90.5%）骨折复位满意，1 例髋螺钉位置不佳，1 例前股骨皮质破裂。平均手术时间为 115 分钟，22 例需要输血，20 例术后出现医学并发症。主要的骨科并发症包括 2 例旋转移位、3 例骨不连和 1 例创伤性假体周围骨折，总失败率为 7.9%。有 4 例远端锁定螺栓断裂或退出。30 天死亡率为 6.5%。
采用 IMHS 获得的临床和影像学结果与其他头髓内装置的结果相当。我们认为长 IMHS 是治疗这些不稳定骨折的良好植入物。
