Faculty of Medicine, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada.
J Orthop Trauma. 2018 Aug;32(8):419-424. doi: 10.1097/BOT.0000000000001179.
The goal of this study was to compare a 3-hole versus a 4-hole sliding hip screw (SHS) in the presence of a retrograde intramedullary (RIM) nail for fixing intertrochanteric and comminuted midshaft femur fractures.
Mechanical tests were performed on 10 matched pairs of human cadaveric femurs that were osteotomized and then fixed using a 3-hole SHS versus the traditional "gold standard" 4-hole SHS in the presence of an RIM nail.
Data showed no differences between the 3-hole SHS with RIM nail versus 4-hole SHS with RIM nail for stiffness (281 ± 127 vs. 260 ± 118 N/mm, P = 0.76), clinical failure at 10 mm of hip displacement (2014 ± 363 vs. 2134 ± 614 N, P = 0.52), or ultimate mechanical failure (3476 ± 776 vs. 3669 ± 755 N, P = 0.12).
For this fracture pattern, a 3-hole SHS with RIM nail may be a suitable surgical alternative to the traditional "gold standard" method because it provides the same biomechanical properties while potentially reducing surgical time, blood loss, and hardware used.
本研究旨在比较逆行髓内钉（RIM）固定下三孔与四孔滑动髋螺钉（SHS）治疗股骨转子间和粉碎型股骨干骨折的效果。
对 10 对配对的人体股骨标本进行了力学测试，这些标本均经过截骨处理，然后分别使用三孔 SHS 和传统的“金标准”四孔 SHS 加 RIM 钉固定。
数据显示，三孔 SHS 加 RIM 钉与四孔 SHS 加 RIM 钉在刚度（281±127 与 260±118 N/mm，P=0.76）、10mm 髋关节位移时的临床失效（2014±363 与 2134±614 N，P=0.52）或最终机械失效（3476±776 与 3669±755 N，P=0.12）方面均无差异。
对于这种骨折模式，三孔 SHS 加 RIM 钉可能是传统“金标准”方法的一种合适的手术替代方法，因为它提供了相同的生物力学特性，同时可能减少手术时间、失血量和使用的硬件。
