Golhisar State Hospital, Turkey.
Sisli Hamidiye Etfal Training and Research Hospital, Halaskargazi Cad., Etfal Sk, 34371, Şişli, İstanbul, Turkey.
Int J Surg. 2018 Aug;56:250-255. doi: 10.1016/j.ijsu.2018.06.035. Epub 2018 Jun 28.
To present the effect of the cerclage fixation, which was performed for the purpose of preserving the alignment obtained by open reduction, on the long-term clinical and radiological results of subtrochanteric fractures.
The inclusion criterias were at least 2 years of follow-up, no severe cognitive impairment, and to be able to walk independently prior to fracture. Patients with transverse or short oblique subtrochanteric hip fractures (AO/OTA class 32-A3.1), patients underwent previous femoral or hip operation for the same side and those with segmental fractures, bilateral fractures and pathological fractures were not included in the study. The clinical and radiological results of the patients were evaluated. The clinical evaluations were performed with Palmer and Parker Mobility Score (PPM), Lower Extremity Functional Score (LEFS), visual analogue score (VAS) and return to pre-injury activity status. The elapsed time between the trauma and the surgery date, the duration of surgery the estimated amount of bleeding, and the length of hospital stay of patients were assessed.
Thirty-two of the 52 patients were female and 20 were male. The mean age of females was 77.80 ± 9.75 years and the mean age of the males was 79.18 ± 6.50 years. The mean follow-up period of the patients was 62.25 ± 34.68 months. The mean time until the patients' surgery was 6.18 ± 3.32 days. The mean duration of surgery was 52.6 ± 13.8 min. The mean amount of bleeding was 176 ± 90 ml. The mean length of patients' hospital stay was 6.2 ± 3.2 days. The postoperative mean duration of union was found to be 3.8 ± 1.6 months. The mean value of varus/valgus angulation in coronal plane measurements was 0.52°. No complication was observed in any patient during the cerclage application. The mean number of wire was 1.3. LEFS difference was statistically significant. PPM decline was not statistically significant.
Open reduction and the use of cerclage did not produce a negative effect in terms of fracture union. The generation of medial support by anatomical reduction of the fracture prevents the implant failure and provide a basis for union.
介绍为了保持切开复位获得的对线而进行的环扎固定对股骨转子下骨折的长期临床和放射学结果的影响。
纳入标准为至少 2 年随访、无严重认知障碍、骨折前能独立行走。不包括横行或短斜型股骨转子下骨折（AO/OTA 32-A3.1 型）、同侧股骨或髋关节既往手术患者以及节段性骨折、双侧骨折和病理性骨折患者。评估患者的临床和放射学结果。临床评估采用 Palmer 和 Parker 活动度评分（PPM）、下肢功能评分（LEFS）、视觉模拟评分（VAS）和恢复到伤前活动状态。评估患者的创伤至手术日期的时间间隔、手术时间、估计出血量和住院时间。
52 例患者中 32 例为女性，20 例为男性。女性平均年龄为 77.80±9.75 岁，男性平均年龄为 79.18±6.50 岁。患者平均随访时间为 62.25±34.68 个月。患者手术平均时间为 6.18±3.32 天。手术平均时间为 52.6±13.8 分钟。平均出血量为 176±90ml。患者平均住院时间为 6.2±3.2 天。术后平均愈合时间为 3.8±1.6 个月。冠状面测量时内翻/外翻角度的平均值为 0.52°。在环扎应用过程中，没有观察到任何患者发生并发症。平均使用线数量为 1.3 根。LEFS 差异有统计学意义。PPM 下降无统计学意义。
切开复位和环扎固定对骨折愈合没有产生负面影响。骨折解剖复位产生的内侧支撑防止了植入物失效，并为愈合提供了基础。
