Hsu Cheng-En, Huang Kui-Chou, Lin Tzu-Chieh, Tong Kwok-Man, Lee Mei-Hsuan, Chiu Yung-Cheng
Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan; Division of Traumatology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
Department of Orthopedics, Asia University Hospital, Taichung, Taiwan; College of Medicine and Health Science, Department of Occupation Therapy, Asia University, Taichung, Taiwan.
Injury. 2016 Nov;47(11):2501-2506. doi: 10.1016/j.injury.2016.09.012. Epub 2016 Sep 6.
Dynamic hip screw (DHS) is a common device for treating intertrochanteric fracture (ITF). Various risk factors have been reported to be associated with the operative treatment outcome. However, an integrated risk scoring prediction model is lacking. In this study, we aimed to develop a prediction model for treatment outcome of intertrochanteric fracture.
We analyzed 442 AO/OTA 31-A1 and A2 fractures which were treated with DHS during the period January 2000 to June 2014 in a level I trauma center. Risk factors including age, gender, injured side, lag screw position, AO/OTA classification, tip-apex distance, postoperative lateral wall fracture, reduction patterns were analyzed to determine their influence on treatment outcome. Integrated risk scores of significant predictors were used to construct a prediction model.
AO/OTA 31-A2 classification, postoperative lateral wall fracture, posteriorly inserted lag screw and varus reduction pattern were significant risk predictors for DHS failure. The failure risk for low- and high-risk groups were significantly different (P<0.001) CONCLUSION: AO/OTA 31-A2 classification, postoperative lateral wall fracture, posteriorly inserted lag screw and varus reduction pattern were significant risk predictors for DHS failure. We developed a model that integrates these factors to predict the treatment outcome, which had excellent prediction accuracy and discriminatory ability. The models may provide useful information for orthopedic doctors to identify patients who need early intervention as well as ITF patients who require more frequent follow-up in the postoperative period.
动力髋螺钉（DHS）是治疗股骨转子间骨折（ITF）的常用器械。已有多种危险因素被报道与手术治疗结果相关。然而，目前缺乏一个综合的风险评分预测模型。在本研究中，我们旨在建立一个股骨转子间骨折治疗结果的预测模型。
我们分析了2000年1月至2014年6月期间在一家一级创伤中心接受DHS治疗的442例AO/OTA 31-A1和A2型骨折。分析年龄、性别、受伤侧、拉力螺钉位置、AO/OTA分类、尖顶距、术后外侧壁骨折、复位方式等危险因素，以确定它们对治疗结果的影响。使用显著预测因素的综合风险评分构建预测模型。
AO/OTA 31-A2分类、术后外侧壁骨折、拉力螺钉后位置入和内翻复位方式是DHS失败的显著风险预测因素。低风险组和高风险组的失败风险有显著差异（P<0.001）。结论：AO/OTA 31-A2分类、术后外侧壁骨折、拉力螺钉后位置入和内翻复位方式是DHS失败的显著风险预测因素。我们开发了一个整合这些因素的模型来预测治疗结果，该模型具有出色的预测准确性和鉴别能力。这些模型可为骨科医生提供有用信息，以识别需要早期干预的患者以及术后需要更频繁随访的股骨转子间骨折患者。
