Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
J Bone Joint Surg Am. 2012 Jul 18;94(14):1266-72. doi: 10.2106/JBJS.K.00357.
Following internal fixation of intertrochanteric hip fractures, tip apex distance, fracture classification, position of the screw in the femoral head, and fracture reduction are known predictors for screw cutout, but the reliability of these measurements is unknown. We investigated the reliability of the tip apex distance measurement, the Cleveland femoral head dividing system, the three-grade classification system of Baumgaertner for fracture reduction, and the AO classification system as predictors for screw cutout.
All patients with an intertrochanteric hip fracture who were managed with either a dynamic hip screw or a gamma nail between January 2007 and June 2010 were evaluated from our hip trauma database.
The tip apex distance measurement was reliable and patients with device cutout had a significantly higher tip apex distance. The agreement between observers with regard to screw position and fracture reduction was moderately reliable. After adjustment for tip apex distance and screw position, A3 fractures were at more risk of cutout compared with A1 fractures. Poor fracture reduction was significantly related with a higher incidence of cutout in univariate analysis, but not in multivariate analysis. Central-inferior and anterior-inferior positions, after adjustment for tip apex distance and screw position, were significantly protective against cutout.
To decrease probable risks of cutout, the tip apex distance needs to stay small or the screw needs to be placed central-inferiorly or anterior-inferiorly.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
股骨转子间骨折内固定术后，尖顶距、骨折分型、股骨头内螺钉位置以及骨折复位是螺钉切出的已知预测因素，但这些测量方法的可靠性尚不清楚。我们研究了尖顶距测量、克利夫兰股骨头分型系统、Baumgaertner 骨折复位三分法以及 AO 骨折分型系统作为螺钉切出预测因素的可靠性。
我们从髋部创伤数据库中评估了 2007 年 1 月至 2010 年 6 月期间采用动力髋螺钉或伽玛钉治疗的所有股骨转子间骨折患者。
尖顶距测量可靠，器械切出的患者尖顶距明显更高。观察者之间在螺钉位置和骨折复位方面的一致性为中度可靠。在调整尖顶距和螺钉位置后，A3 型骨折比 A1 型骨折更有可能发生切出。在单因素分析中，骨折复位不良与切出发生率升高显著相关，但在多因素分析中不相关。在调整尖顶距和螺钉位置后，中心-下和前-下位置显著降低了切出的风险。
为了降低切出的可能风险，尖顶距需要保持较小，或者螺钉需要放置在中心-下或前-下位置。
治疗性 III 级。请参阅作者说明，以获取完整的证据水平描述。
