Irgit Kaan, Richard Raveesh D, Beebe Michael J, Bowen Thomas R, Kubiak Erik, Horwitz Daniel S
*Department of Orthopaedic Surgery, Liv Hospital, Istanbul, Turkey; †Department of Orthopaedic Surgery, Geisinger Clinic, Danville, PA; and ‡University of Utah Health Care Orthopaedic Center, Salt Lake City, UT.
J Orthop Trauma. 2015 Sep;29(9):e299-304. doi: 10.1097/BOT.0000000000000340.
To evaluate the healing rate, complications, role of reduction and screw placement, and the 1-year mortality in the treatment of reverse oblique and transverse intertrochanteric femoral fractures treated with the long cephalomedullary nail.
Retrospective review.
Two different Level-1 trauma centers: Geisinger Medical Center and the University of Utah.
One hundred forty-eight patients with intertrochanteric fractures (AO/OTA class 31-A3) eligible for review. All patients had a minimum of 12 months of follow-up and were available for radiologic checks and assessment of outcomes and complications.
Long cephalomedullary nail.
Medical records were reviewed for reoperation, demographic parameters, length of hospital stay, estimated blood loss, and need for transfusion. Mortality rates at 1 month, 6 months, and 1 year were also recorded. Patients were followed clinically and radiographically at 6 weeks, 3 months, 6 months, 12 months, and yearly as needed.
The average age of patients was 69.9 (range, 19-95) years. Average length of follow-up was 53 (range, 12-148) months. The average surgical time was 71.8 (range, 26-229) minutes. Twenty-four patients (16%) required blood transfusions, and the average transfusion required was 205.1 mL (range, 20-800). Five different long nail designs were used to treat the patients. One patient (0.6%) experienced an intraoperative complication. Eighteen patients (12%) sustained postoperative complications. Twelve (8%) patients required reoperations. One-year mortality rates were 10.1%.
Long cephalomedullary nails remain the preferred treatment option for the treatment of 31-A3-type fractures, demonstrating acceptable complication rates, low reoperation rates, and high rates of healing.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
评估使用加长型股骨近端髓内钉治疗反向斜行和横行股骨转子间骨折的愈合率、并发症、复位及螺钉置入的作用以及1年死亡率。
回顾性研究。
两个不同的一级创伤中心：盖辛格医疗中心和犹他大学。
148例符合评估条件的转子间骨折患者（AO/OTA 31-A3型）。所有患者至少随访12个月，且可进行影像学检查及结局和并发症评估。
加长型股骨近端髓内钉。
查阅病历以了解再次手术情况、人口统计学参数、住院时间、估计失血量及输血需求。记录1个月、6个月和1年时的死亡率。患者在术后6周、3个月、6个月、12个月及必要时每年进行临床和影像学随访。
患者平均年龄69.9岁（范围19 - 95岁）。平均随访时间53个月（范围12 - 148个月）。平均手术时间71.8分钟（范围26 - 229分钟）。24例患者（16%）需要输血，平均输血量为205.1毫升（范围20 - 800毫升）。使用了5种不同的加长型髓内钉设计治疗患者。1例患者（0.6%）发生术中并发症。18例患者（12%）出现术后并发症。12例（8%）患者需要再次手术。1年死亡率为10.1%。
加长型股骨近端髓内钉仍是治疗31-A3型骨折的首选治疗方法，其并发症发生率可接受，再次手术率低，愈合率高。
治疗性四级证据。有关证据级别的完整描述，请参阅作者指南。
