McGill University Health Centre, 1650 Cedar Avenue, B5 159, Montreal, QC H3G 1A4, Canada. E-mail address for R. Reindl:
McGill University Health Centre, V Pavilion, 687, Avenue des Pins Ouest, Montreal, QC H3A 1A1, Canada.
J Bone Joint Surg Am. 2015 Dec 2;97(23):1905-12. doi: 10.2106/JBJS.N.01007.
The use of intramedullary devices for the management of intertrochanteric fractures has steadily increased without good evidence of their clinical efficacy. This prospective randomized multicenter study was designed to compare the clinical and radiographic outcomes of patients who had been treated with a traditional extramedullary hip screw for an unstable (AO/OTA 31-A2) intertrochanteric hip fracture with those of patients who had been treated with the newer intramedullary device for the same injury.
The Lower Extremity Measure (LEM) was used as the primary hip-specific outcome tool. The Functional Independence Measure (FIM), the timed "Up & Go" (TUG) test, as well as a timed two-minute walk test were used as secondary clinical outcome tools. Specific radiographic parameters were collected to assess for fracture movement, heterotopic ossification, and implant failure.
No significant differences were noted between the intramedullary and extramedullary treatment arms with regard to either the primary or the secondary clinical outcome tools. The radiographic parameters favored the intramedullary treatment arm, which had less femoral neck shortening.
While the use of the intramedullary devices led to better radiographic outcomes in this study, this did not translate to improved functional outcomes.
髓内装置在治疗转子间骨折中的应用稳步增加，但缺乏其临床疗效的良好证据。这项前瞻性随机多中心研究旨在比较使用传统的髓外髋螺钉治疗不稳定（AO/OTA 31-A2）转子间髋部骨折的患者与使用新型髓内装置治疗同一损伤的患者的临床和影像学结果。
下肢测量（LEM）被用作主要的髋关节特异性结果工具。功能性独立测量（FIM）、计时“站起来和走”（TUG）测试以及计时两分钟步行测试被用作次要临床结果工具。收集特定的影像学参数来评估骨折移位、异位骨化和植入物失败。
在主要和次要临床结果工具方面，髓内和髓外治疗组之间没有显著差异。影像学参数倾向于髓内治疗组，其股骨颈缩短较少。
虽然在这项研究中，髓内装置的使用导致了更好的影像学结果，但这并没有转化为改善的功能结果。
