Bojan Alicja J, Jönsson Anders, Granhed Hans, Ekholm Carl, Kärrholm Johan
Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Sweden.
Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Sweden.
Injury. 2018 Mar;49(3):673-679. doi: 10.1016/j.injury.2018.01.005. Epub 2018 Jan 12.
Cut-out complication remains a major unsolved problem in the treatment of trochanteric hip fractures. A better understanding of the three-dimensional fracture-implant motions is needed to enable further development of clinical strategies and countermeasures. The aim of this clinical study was to characterise and quantify three-dimensional motions between the implant and the bone and between the lag screw and nail of the Gamma nail. Radiostereometry Analysis (RSA) analysis was applied in 20 patients with trochanteric hip fractures treated with an intramedullary nail. The following three-dimensional motions were measured postoperatively, at 1 week, 3, 6 and 12 months: translations of the tip of the lag screw in the femoral head, motions of the lag screw in the nail, femoral head motions relative to the nail and nail movements in the femoral shaft. Cranial migration of the tip of the lag screw dominated over the other two translation components in the femoral head. In all fractures the lag screw slid laterally in the nail and the femoral head moved both laterally and inferiorly towards the nail. All femoral heads translated posteriorly relative to the nail, and rotations occurred in both directions with median values close to zero. The nail tended to retrovert in the femoral shaft. Adverse fracture-implant motions were detected in stable trochanteric hip fractures treated with intramedullary nails with high resolution. Therefore, RSA method can be used to evaluate new implant designs and clinical strategies, which aim to reduce cut-out complications. Future RSA studies should aim at more unstable fractures as these are more likely to fail with cut-out.
在股骨转子间骨折的治疗中，切出并发症仍然是一个主要的未解决问题。需要更好地理解三维骨折-植入物运动，以促进临床策略和对策的进一步发展。本临床研究的目的是描述和量化植入物与骨骼之间以及Gamma钉的拉力螺钉与钉之间的三维运动。对20例接受髓内钉治疗的股骨转子间骨折患者应用放射立体测量分析（RSA）。术后1周、3个月、6个月和12个月测量以下三维运动：拉力螺钉尖端在股骨头内的平移、拉力螺钉在钉内的运动、股骨头相对于钉的运动以及钉在股骨干内的运动。拉力螺钉尖端的头侧移位在股骨头的其他两个平移分量中占主导地位。在所有骨折中，拉力螺钉在钉内横向滑动，股骨头向钉的方向横向和下方移动。所有股骨头相对于钉向后平移，并且在两个方向上都发生旋转，中位数接近零。钉在股骨干内有后倾趋势。在接受高分辨率髓内钉治疗的稳定股骨转子间骨折中检测到了不良的骨折-植入物运动。因此，RSA方法可用于评估旨在减少切出并发症的新植入物设计和临床策略。未来的RSA研究应针对更不稳定的骨折，因为这些骨折更有可能因切出而失败。
