Li Qing, Zhang Shimin
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014 Sep;28(9):1177-80.
To summarize the progress on the distal interlocking screw of cephalomedullary nail for intertrochanteric fractures.
Related literature concerning the distal interlocking screw of cephalomedullary nail was reviewed and analyzed in terms ofbiomechanics, clinical application, operating difficulties, and complications.
Distal interlocking screw can provide extra torsional stiffness in both short and long cephalomedullary nail. It is applied in most clinical cases. In long cephalomedullary nail, placing the distal interlocking screw increases the operative time for fixation and the amount of radiation exposure notably. In short cephalomedullary nail, placing the distal interlocking screw can cause adjacent vascular injury, stress concentration, and secondary fracture around the screw.
When the fracture is stable (type A1, type A2.1), it can be fixed solidly without the distal interlocking screw, but prefers to use a long nail. In unstable fracture, the distal interlocking screw should be used to prevent rotational displacement of the femur shaft and the failure of the nail.
总结股骨近端髓内钉治疗股骨转子间骨折时远端锁定螺钉的研究进展。
回顾并分析有关股骨近端髓内钉远端锁定螺钉的相关文献，内容涉及生物力学、临床应用、操作难点及并发症。
远端锁定螺钉可为长短两种股骨近端髓内钉提供额外的抗扭转刚度，多数临床病例中均有应用。在长髓内钉中，置入远端锁定螺钉会显著增加固定手术时间及辐射暴露量。在短髓内钉中，置入远端锁定螺钉可导致相邻血管损伤、应力集中及螺钉周围继发骨折。
骨折稳定时（A1型、A2.1型），可不使用远端锁定螺钉而牢固固定，但更倾向于使用长钉。在不稳定骨折中，应使用远端锁定螺钉以防止股骨干旋转移位及髓内钉失效。
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