现代指甲几何形状是否会影响老年髋部骨折患者股骨远端的定位？比较曲率半径为 200 厘米和 150 厘米的相同髓内钉。

Does modern nail geometry affect positioning in the distal femur of elderly patients with hip fractures? A comparison of otherwise identical intramedullary nails with a 200 versus 150 cm radius of curvature.

机构信息

Harris Methodist Fort Worth Hospital and John Peter Smith Orthopaedic Surgery Residency Program, Fort Worth, TX 76104, USA.

出版信息

J Orthop Trauma. 2013 Jun;27(6):299-302. doi: 10.1097/BOT.0b013e318283f231.

DOI:10.1097/BOT.0b013e318283f231

PMID:23287751

Abstract

OBJECTIVE

To compare implant positioning in the distal femur between 2 cohorts of elderly patients treated for a hip fracture with a long 200- or 150-cm radius of curvature (ROC) cephalomedullary nail. We theorized that the 150-cm ROC nails would more closely approximate the femoral bow and result in fewer implant-related complications.

DESIGN

Retrospective Comparative Study.

SETTING

Single Level II Trauma Center.

PARTICIPANTS

Fifty-eight geriatric patients with a hip fracture (26 in 200-cm nail cohort and 32 in 150-cm nail cohort).

INTERVENTION

Long cephalomedullary nailing using single hip fracture nail and instrumentation system (InterTAN) before and after transition from a 200- to 150-cm ROC long hip nail.

MAIN OUTCOME MEASURES

Anteroposterior position of distal nail tip on intraoperative lateral radiograph (where 0.50 indicates midaxial, perfectly central placement) and implant-related complications (anterior cortical abutment, perforation, or fracture).

RESULTS

The average position of nails with a 150-cm ROC was closer to the midaxial line of the distal femur compared with 200-cm nails (0.63 vs. 0.55, P = 0.02). Only 1 of 26 (3.8%) 200-cm ROC nails was placed at the midaxial line and none were posterior, whereas 9 of 32 (28%) 150-cm ROC nails were positioned at or posterior to this line (P = 0.006). Only 1 nail with a 150-cm ROC abutted the distal femur's anterior cortex compared with 3 in the 200-cm cohort-including one that caused a fracture.

CONCLUSIONS

Femoral nails with a 150-cm ROC more closely approximate the femoral bow of geriatric hip fracture patients than 200-cm ROC nails, appearing less likely to cause complications such as anterior cortical abutment, perforation, or fracture.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

比较使用两种不同半径（200cm 和 150cm）的股骨近端髓内钉治疗老年股骨转子间骨折患者的植入物在股骨远端的定位情况。我们推测，150cm 半径的髓内钉更接近股骨弓的形状，从而减少与植入物相关的并发症。

设计

回顾性比较研究。

地点

单级 II 型创伤中心。

参与者

58 例老年股骨转子间骨折患者（200cm 髓内钉组 26 例，150cm 髓内钉组 32 例）。

干预

在从 200cm 半径改为 150cm 半径长髓内钉之前和之后，使用单髋骨折钉和器械系统（InterTAN）进行长股骨髓内钉固定。

主要观察指标

术中侧位 X 线片上远端钉尖的前后位置（0.50 表示中轴，完全位于中心）和与植入物相关的并发症（前皮质接触、穿透或骨折）。

结果

150cm 半径的髓内钉的平均位置比 200cm 半径的髓内钉更接近股骨远端的中轴（0.63 比 0.55，P=0.02）。26 例 200cm 半径的髓内钉中只有 1 例（3.8%）位于中轴线上，没有位于中轴后，而 32 例 150cm 半径的髓内钉中有 9 例（28%）位于或位于该线之后（P=0.006）。只有 1 例 150cm 半径的髓内钉与股骨远端前皮质接触，而 200cm 半径的髓内钉中有 3 例接触，包括 1 例导致骨折。