Furui Atsuo, Terada Nobuki
Department of Orthopaedic Surgery, Fujita Health University, Banbuntane Houtokukai Hospital, Nagoya 454-8509,
Acta Med Okayama. 2017 Aug;71(4):269-277. doi: 10.18926/AMO/55303.
Achieving sufficient support of the anterior cortex of the femoral neck is a fundamental goal of the reduction of trochanteric fractures. However, anterior-cortex support is often lost after the fracture reduction. Our aim was to analyze factors contributing to the postoperative displacement of an acceptably reduced trochanteric fracture. The cases of 40 patients with a post-reduction Ikuta subtype N fracture alignment were reviewed. All fractures were fixed with 135° free-sliding plates. On postoperative day 14, patients were classified into two groups: those with retention of the Ikuta subtype N alignment, and those with progression to Ikuta subtype P alignment. The clinical and radiological factors were evaluated between the groups. In addition, to define one of the factors, i.e., the postoperative rotational displacement between the proximal and distal fragments, the relationship between radiographic findings and computed tomography image measurements was assessed in 15 of the 40 patients. Angulation at the fracture site on lateral view radiographs was defined as postoperative rotational displacement, and unstable trochanteric fractures and postoperative rotational displacement were identified as significant risk factors for the postoperative displacement. Therefore, cautious and careful follow-up is warranted for patients with unstable trochanteric fractures or fractures having rotational displacement.
获得股骨颈前皮质的足够支撑是转子间骨折复位的一个基本目标。然而，骨折复位后前皮质支撑常常丧失。我们的目的是分析导致复位良好的转子间骨折术后移位的因素。回顾了40例复位后为Ikuta N型骨折对线患者的病例。所有骨折均用135°自由滑动钢板固定。术后第14天，患者被分为两组：维持Ikuta N型对线的患者和进展为Ikuta P型对线的患者。对两组之间的临床和影像学因素进行了评估。此外，为了确定其中一个因素，即近端和远端骨折块之间的术后旋转移位，在40例患者中的15例中评估了X线表现与计算机断层扫描图像测量之间的关系。侧位X线片上骨折部位的成角被定义为术后旋转移位，不稳定转子间骨折和术后旋转移位被确定为术后移位的显著危险因素。因此，对于不稳定转子间骨折或有旋转移位的骨折患者，需要谨慎仔细的随访。
