Cho Myung Rae, Lee Jae Hyuk, Kwon Jai Bum, Do Jung Suk, Chae Seung Bum, Choi Won-Kee
Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea.
Clin Orthop Surg. 2018 Sep;10(3):292-298. doi: 10.4055/cios.2018.10.3.292. Epub 2018 Aug 22.
We evaluated the radiological and clinical results of reduction using a dynamic hip screw according to the grade of medial cortical support in patients with AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification type 31-A2 pertrochanteric fractures.
We enrolled 100 patients with AO/OTA type 31-A2 fractures with displaced lesser trochanter fragments (length of the cortical area longer than 20 mm on the pelvis anteroposterior view). Patients with positive medial cortical support were assigned to group 1 (n = 28); neutral medial cortical support, group 2 (n = 42); and negative medial cortical support, group 3 (n = 30). Radiological evaluation was done by measuring the change in the femoral neck-shaft angle and sliding distance of the lag screw. Clinical outcomes of each group were compared by means of the walking ability score proposed by Ceder.
Group 1 showed significantly less changes in the femoral neck-shaft angle and shorter sliding distance than groups 2 and 3. Group 2 showed significantly less changes in the femoral neck-shaft angle and shorter sliding distance than group 3. Group 1 showed significantly higher walking ability scores than group 3 ( = 0.00). The use of trochanter stabilizing plates or fixation using wires for posteromedial wall defect resulted in no significant changes in terms of the femoral neck-shaft angle or sliding distance.
In the treatment of pertrochanteric fractures accompanied by posteromedial wall defect using a dynamic hip screw, reduction with negative cortical support should be avoided.
我们根据AO骨科学与创伤协会（AO/OTA）31 - A2型转子周围骨折患者内侧皮质支撑的分级，评估了使用动力髋螺钉复位的放射学和临床结果。
我们纳入了100例AO/OTA 31 - A2型骨折且小转子骨折块移位（骨盆前后位片上皮质区域长度超过20mm）的患者。内侧皮质支撑阳性的患者被分配到第1组（n = 28）；内侧皮质支撑中性的患者为第2组（n = 42）；内侧皮质支撑阴性的患者为第3组（n = 30）。通过测量股骨颈干角的变化和拉力螺钉的滑动距离进行放射学评估。采用Ceder提出的步行能力评分比较每组的临床结果。
第1组股骨颈干角的变化明显小于第2组和第3组，滑动距离也更短。第2组股骨颈干角的变化明显小于第3组，滑动距离也更短。第1组的步行能力评分明显高于第3组（P = 0.00）。使用转子稳定钢板或用钢丝固定后内侧壁缺损，在股骨颈干角或滑动距离方面没有显著变化。
在使用动力髋螺钉治疗伴有后内侧壁缺损的转子周围骨折时，应避免皮质支撑阴性的复位。
