Vaughn Josh, Cohen Eric, Vopat Bryan G, Kane Patrick, Abbood Emily, Born Christopher
Rhode Island Hospital, Providence, Rhode Island, USA,
Eur J Orthop Surg Traumatol. 2015 May;25(4):665-70. doi: 10.1007/s00590-014-1557-2. Epub 2014 Oct 22.
Hip fractures are becoming increasingly common resulting in significant morbidity, mortality and raising healthcare costs. Both short and long cephalomedullary devices are currently employed to treat intertrochanteric hip fractures. However, which device is optimal continues to be debated as each implant has unique characteristics and theoretical advantages. This study looked to identify rates of complications associated with both long and short cephalomedullary nails for the treatment of intertrochanteric hip fractures.
We retrospectively reviewed charts from 2006 to 2011, and we identified 256 patients were identified with AO class 31.1-32.3 fractures. Sixty were treated with short nails and 196 with long nails. Radiographs and charts were then analysed for failures and hardware complications.
Catastrophic failure and hardware complication rates were not statistically different between short or long cephalomedullary nails. The overall catastrophic failure rate was 3.1 %; there was a 5 % failure rate in the short-nail group compared with a 2.6 % failure rate in the long-nail group (p = 0.191). There was a 3.33 % secondary femur fracture rate in the short-nail group, compared with none in the long-nail cohort (p = 0.054). The rate of proximal fixation failure was 1.67 % for the short-nail group and 2.0 % in the long-nail group (p = 0.406).
Our data suggests equivocal outcomes as measured by similar catastrophic failure rate between both short and long cephalomedullary nails for intertrochanteric femur fractures. However, there was an increased risk of secondary femur fracture with short cephalomedullary nails when compared to long nails that approached statistical significance.
髋部骨折正变得越来越常见，导致了显著的发病率、死亡率，并增加了医疗成本。目前，短型和长型髓内钉装置都被用于治疗股骨转子间骨折。然而，由于每种植入物都有独特的特性和理论优势，哪种装置是最佳选择仍存在争议。本研究旨在确定使用短型和长型髓内钉治疗股骨转子间骨折的并发症发生率。
我们回顾性分析了2006年至2011年的病历，确定了256例AO 31.1 - 32.3级骨折患者。其中60例接受短型髓内钉治疗，196例接受长型髓内钉治疗。然后分析X线片和病历，以确定失败情况和内固定并发症。
短型和长型髓内钉的灾难性失败率和内固定并发症发生率在统计学上没有差异。总体灾难性失败率为3.1%；短型髓内钉组的失败率为5%，而长型髓内钉组为2.6%（p = 0.191）。短型髓内钉组的二次股骨骨折发生率为3.33%，而长型髓内钉组未发生（p = 0.054）。短型髓内钉组的近端固定失败率为1.67%，长型髓内钉组为2.0%（p = 0.406）。
我们的数据表明，对于股骨转子间骨折，短型和长型髓内钉的灾难性失败率相似，治疗结果难以明确。然而，与长型髓内钉相比，短型髓内钉导致二次股骨骨折的风险增加，接近统计学意义。
