Lanzetti Riccardo Maria, Caraffa Auro, Lupariello Domenico, Ceccarini Paolo, Gambaracci Giulio, Meccariello Luigi, Manfreda Francesco, Maiettini Daniele, Vicente Cristina Ibáñez, Scialpi Michele, Bisaccia Olga, Rinonapoli Giuseppe, Bisaccia Michele
U.O.C. Orthopedics and Traumatology Department, SM Misericordia Hospital, University of Perugia, Perugia, Italy.
University of Rome, La Sapienza, Rome, Italy.
Eur J Orthop Surg Traumatol. 2018 May;28(4):649-658. doi: 10.1007/s00590-018-2143-9. Epub 2018 Feb 9.
Intertrochanteric fractures are of great interest worldwide and are the most frequently operated fractures. Intramedullary nailing is commonly used in the treatment of intertrochanteric fractures. The purpose of this study is to assess the necessity of using the distal blocking screw in 31-A1 and 31-A2 fractures, classified according to the Orthopaedic Trauma Association classification system (AO/OTA).
This is a prospective study of 143 consecutive patients (mean age 85.01 years, mean final follow-up 14.1 months) surgically treated with the same intramedullary nail. In 75 cases, the distal locking screw was not used. Parameters evaluated during follow-up were: blood loss, transfusion requirements, surgery duration, and fluoroscopy time. Harris Hip Score and Barthel Activity Daily Living were used for the clinical evaluation. Radiographic Union Score For Hip (RUSH score) and Tip apex distance (TAD) were measured for radiologic evaluation.
The group treated without locking screw showed significantly shorter surgical duration time (31.9 vs. 47.2 min), a decrease in blood loss (variation Hb - 1.06 vs. - 1.97), and reduced X-rays exposure time (25.4 vs. 31.6 s). No significant differences were observed in the postoperative period and in the radiographic and clinical scores.
This study demonstrates that in intertrochanteric 31-A1 and 31-A2 stable fractures, the absence of distal locking screw does not compromise bone healing and prevents several clinical complications.
转子间骨折在全球范围内备受关注，是最常接受手术治疗的骨折类型。髓内钉固定常用于治疗转子间骨折。本研究的目的是评估根据骨科创伤协会分类系统（AO/OTA）分类的31 - A1和31 - A2型骨折中使用远端阻挡螺钉的必要性。
这是一项对143例连续患者（平均年龄85.01岁，平均末次随访14.1个月）进行的前瞻性研究，这些患者均接受了相同的髓内钉手术治疗。其中75例未使用远端锁定螺钉。随访期间评估的参数包括：失血量、输血需求、手术时长和透视时间。采用Harris髋关节评分和Barthel日常生活活动能力评分进行临床评估。采用髋关节影像学愈合评分（RUSH评分）和尖顶距（TAD）进行影像学评估。
未使用锁定螺钉治疗的组手术持续时间显著缩短（31.9对47.2分钟），失血量减少（血红蛋白变化 - 1.06对 - 1.97），X线暴露时间缩短（25.4对31.6秒）。术后以及影像学和临床评分方面未观察到显著差异。
本研究表明，在31 - A1和31 - A2型转子间稳定骨折中，不使用远端锁定螺钉不会影响骨折愈合，且可预防多种临床并发症。
