Hirakawa Yohei, Nakamura Hidehiro, Minamitani Kazuhito, Hashida Ryuki, Gotoh Masafumi, Shiba Naoto
Department of Orthpaedics, Munakata Suikokai General Hospital, 5-7-1 Himakino, Fukutu, Fukuoka, 811-3298, Japan.
Department of Orthopaedics, Kurume Unversity, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
J Orthop Surg Res. 2017 Feb 22;12(1):33. doi: 10.1186/s13018-017-0533-z.
Here, we assessed the prognostic value of the early sliding length (ESL) for predicting the risk of non-union after internal fixation of femoral neck fractures (FNFs) by Dual SC Screws (DSCS).
A retrospective analysis of 86 patients with intra-capsular FNFs was performed. They underwent osteosynthesis by DSCS at our institution between 2008 and 2013 with a minimum follow-up duration of 6 months. Preoperative displacement, fracture reduction quality, ESL of screws at 2 weeks postoperatively, and correlation of non-union with the ESL of screws were evaluated.
Bone union without complications was achieved in 74 patients (86.0%), whereas 12 patients (14.0%) showed non-union. The ESL was significantly longer in the non-union group (proximal 3.94 ± 2.79 mm, distal 4.03 ± 3.16 mm) than in the union group (proximal 0.98 ± 1.85 mm, distal 1.01 ± 1.84 mm, P = 0.0001* for proximal, P < 0.0001* for distal). The ESL was significantly associated with non-union, both in the proximal [P = 0.0002, unit odds ratio (OR) 1.58, 95% confidence interval (CI) 1.23-2.16] and distal screws (P = 0.0002, unit OR 1.53, 95% CI 1.21-2.02). The areas under the ROC curves for the ESL of proximal and distal screws were 0.845 and 0.867, respectively; the cut-off values to predict non-union were 1.0 mm (sensitivity 91.7% and specificity 74.3%) and 1.4 mm (sensitivity 83.3% and specificity 81.1%), respectively.
In this study, the ESL was a good predictor of postoperative non-union in patients with FNFs fixed by DSCS.
在此，我们评估了早期滑动长度（ESL）对预测双皮质螺钉（DSCS）内固定股骨颈骨折（FNF）后骨不连风险的预后价值。
对86例囊内FNF患者进行回顾性分析。2008年至2013年期间，他们在我们机构接受了DSCS接骨术，最短随访时间为6个月。评估术前移位、骨折复位质量、术后2周时螺钉的ESL以及骨不连与螺钉ESL的相关性。
74例患者（86.0%）实现了无并发症的骨愈合，而12例患者（14.0%）出现骨不连。骨不连组的ESL明显长于愈合组（近端3.94±2.79mm，远端4.03±3.16mm），而愈合组近端为0.98±1.85mm，远端为1.01±1.84mm，近端P = 0.0001*，远端P < 0.0001*）。ESL与骨不连显著相关，无论是近端螺钉[P = 0.0002，单位比值比（OR）1.58，95%置信区间（CI）1.23 - 2.16]还是远端螺钉（P = 0.0002，单位OR 1.53，95%CI 1.21 - 2.02）。近端和远端螺钉ESL的ROC曲线下面积分别为0.845和0.867；预测骨不连的截断值分别为1.0mm（敏感性91.7%，特异性74.3%）和1.4mm（敏感性83.3%，特异性81.1%）。
在本研究中，ESL是DSCS固定FNF患者术后骨不连的良好预测指标。
