Hsu Cheng-En, Chiu Yung-Cheng, Tsai Sheng-Heng, Lin Tzu-Chieh, Lee Mei-Hsuan, Huang Kui-Chou
Department of Orthopedics, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Boulevard, Xitun District, Taichung City 407, Taiwan; Division of Traumatology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, No. 155 Li-Nong Street, Section 2, Peitou, Taipei 112, Taiwan.
Department of Orthopedics, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Boulevard, Xitun District, Taichung City 407, Taiwan; Department of Nursing, HungKuang University, Taichung, Taiwan.
Injury. 2015;46(6):1047-53. doi: 10.1016/j.injury.2015.03.007. Epub 2015 Mar 10.
For AO/OTA 31-A2 fractures (A2 fractures) treated with dynamic hip screw (DHS), postoperative lateral wall fracture (PLWF) is thought to be a major cause of femoral medialisation and reoperation. Though trochanter stabilising plate (TSP) had been reported to have a good effect in preventing femoral medialization, its effects and indication in A2 fractures remain controversial. We hypothesized that TSP may improve treatment outcomes in patients with high risk of postoperative lateral femoral wall fractures. The purpose of this study was to investigate (1) the main risk factors predictive of PLWF in A2 fractures and, (2) whether TSP can improve treatment outcomes in patients with high risk of PLWF.
Two hundred and fifty-two A2 fractures treated with DHS or DHS and TSP (DHS-TSP) during January 2000 and June 2013 were enrolled in this study. Standard univariate and multivariate analyses were performed to determine statistically significant risk factors for PLWF in 205 patients who were treated with DHS alone. The risk factor found to be associated with PLWF was utilized to include 171 patients who were at high risk of PLWF. Standard univariate and multivariate analyses were performed to evaluate the effect of TSP on treatment outcomes.
Lateral wall thickness was found to be the main risk factor for PLWF in A2 fractures. A lateral wall thickness of 2.24 cm was found to be the best cutoff point to determine which patients were at high risk for PLWF. In 171 patients with a lateral wall thickness less than 2.24 cm, patients treated with DHS-TSP had significantly decreased lag screw sliding distances, PLWF rate, and reoperation rate (P=0.028, <0.001 and P=0.003, respectively) compared to the corresponding values of those treated with DHS alone. In the multivariate analysis, TSP decreased the reoperation rate by 13 times compared to that of patients who were treated with DHS alone.
Lateral wall thickness is the main risk factor for PLWF in A2 fractures treated with DHS. Use of TSP in A2 fractures with critical thin lateral wall thickness <2.24 cm can significantly decrease the lag screw sliding distances, PLWF rate and reoperation rate.
对于采用动力髋螺钉（DHS）治疗的AO/OTA 31 - A2型骨折（A2骨折），术后外侧壁骨折（PLWF）被认为是股骨内移和再次手术的主要原因。尽管有报道称转子稳定钢板（TSP）在预防股骨内移方面效果良好，但其在A2骨折中的作用和适应证仍存在争议。我们假设TSP可能会改善术后股骨外侧壁骨折高危患者的治疗效果。本研究的目的是调查（1）A2骨折中预测PLWF的主要危险因素，以及（2）TSP是否能改善PLWF高危患者的治疗效果。
本研究纳入了2000年1月至2013年6月期间采用DHS或DHS联合TSP（DHS - TSP）治疗的252例A2骨折患者。对仅接受DHS治疗的205例患者进行标准单因素和多因素分析，以确定PLWF的统计学显著危险因素。将发现与PLWF相关的危险因素用于纳入171例PLWF高危患者。进行标准单因素和多因素分析以评估TSP对治疗效果的影响。
发现外侧壁厚度是A2骨折中PLWF的主要危险因素。发现外侧壁厚度2.24 cm是确定哪些患者为PLWF高危患者的最佳截断点。在171例外侧壁厚度小于2.24 cm的患者中，与仅接受DHS治疗的患者相比，接受DHS - TSP治疗的患者的拉力螺钉滑动距离、PLWF发生率和再次手术率均显著降低（分别为P = 0.028、<0.001和P = 0.003）。在多因素分析中，与仅接受DHS治疗的患者相比，TSP使再次手术率降低了13倍。
外侧壁厚度是采用DHS治疗的A2骨折中PLWF的主要危险因素。在外侧壁厚度临界值<2.24 cm的A2骨折中使用TSP可显著降低拉力螺钉滑动距离、PLWF发生率和再次手术率。
