Ito Juji, Takakubo Yuya, Sasaki Kan, Sasaki Junya, Owashi Kazuya, Takagi Michiaki
Department of Orthopaedic Surgery, Nihonkai General Hospital, 30 Akihocho, Sakata, Yamagata, 998-8501, Japan,
Arch Orthop Trauma Surg. 2015 May;135(5):651-7. doi: 10.1007/s00402-015-2200-3. Epub 2015 Mar 24.
Lag screw cut-out is one of the major postoperative complications on femoral trochanteric fractures. However, precise analyses of excessive sliding and lag screw cut-out were limited. The purpose of this study was to investigate the factors that induce this unfavorable event.
From April 2010 to April 2013, 226 patients were operated in our institute using a short femoral nail. Among them, 177 patients (29 males and 148 females) with a mean age of 84 years (60-97 years), who were followed up >3 months, were included in this study. The postoperative sliding distance, fracture type (AO/OTA classification), tip-apex distance (TAD), reduction pattern in the postoperative X-ray (antero-posterior and lateral views), bone quality (canal flare and cortical indices), walking ability at the time of pre-injury and final follow-up, and complications were investigated retrospectively.
The mean sliding distance was 3.7 mm, and one cut-out case (0.6 %) was observed. The sliding distance of the AO/OTA 31-A2 fractures was significantly longer than that of the A1 fractures (p < 0.0001). Regarding the reduction pattern, the sliding distance of the intramedullary type was longer than that of the extramedullary and anatomical types in the lateral view (p < 0.01, p < 0.001, respectively). Further, even in the medial and anatomical types, where the reduction patterns are recommended in the antero-posterior view, the sliding distance of the intramedullary type was significantly longer than that of the anatomical type in the lateral view. There was no correlation of bone quality with the sliding distance.
Because the sliding distance increased in the intramedullary type in the lateral view of unstable fractures, an accurate reduction in the lateral view at surgery is important, particularly in unstable fractures.
拉力螺钉穿出是股骨转子间骨折术后的主要并发症之一。然而，对于过度滑动和拉力螺钉穿出的精确分析有限。本研究的目的是调查导致这一不良事件的因素。
2010年4月至2013年4月，我院对226例患者采用股骨近端短钉进行手术。其中，177例患者（29例男性和148例女性），平均年龄84岁（60 - 97岁），随访时间超过3个月，纳入本研究。回顾性调查术后滑动距离、骨折类型（AO/OTA分类）、尖顶距（TAD）、术后X线片（前后位和侧位）的复位方式、骨质（髓腔扩宽和皮质指数）、伤前及末次随访时的行走能力以及并发症。
平均滑动距离为3.7mm，观察到1例穿出病例（0.6%）。AO/OTA 31 - A2型骨折的滑动距离明显长于A1型骨折（p < 0.0001）。关于复位方式，在侧位片上，髓内型的滑动距离长于髓外型和解剖型（分别为p < 0.01，p < 0.001）。此外，即使在前后位片推荐复位方式的内侧型和解剖型中，在侧位片上髓内型的滑动距离也明显长于解剖型。骨质与滑动距离无相关性。
由于不稳定骨折侧位片上髓内型的滑动距离增加，因此手术时侧位片的精确复位很重要，尤其是在不稳定骨折中。
