Park Cheon-Gon, Yoon Taek-Rim, Park Kyung-Soon
Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Hip Pelvis. 2018 Dec;30(4):254-259. doi: 10.5371/hp.2018.30.4.254. Epub 2018 Dec 6.
Internal fixation using compression hip screws (CHS) and traction tables placing patients in the supine position is a gold standard option for treating intertrochanteric fractures; however, at our institution, we approach this treatment with patients in a lateral decubitus position. Here, the results of 100 consecutive elderly (i.e., ≥45 years of age) patients who underwent internal fixation with CHS in lateral decubitus position are analyzed.
Between March 2009 and May 2011, 100 consecutive elderly patients who underwent internal fixation with CHS for femoral intertrochanteric fracture were retrospectively reviewed. Clinical outcomes (i.e., Koval score, Harris hip score [HHS]) and radiographic outcomes (i.e., bone union time, amount of sliding of lag screw, tip-apex distance [TAD]) were evaluated.
Clinical assessments revealed that the average postoperative Koval score decreased from 1.4 to 2.6 (range, 0-5; <0.05); HHS was 85 (range, 72-90); and mean bone union time was 5.0 (range, 2.0-8.2) months. Radiographic assessments revealed that anteroposterior average TAD was 6.95 (range, 1.27-14.63) mm; lateral average TAD was 7.26 (range, 1.20-18.43) mm; total average TAD was 14.21 (range, 2.47-28.66) mm; average lag screw sliding was 4.63 (range, 0-44.81) mm; and average angulation was varus 0.72°(range, -7.6°-12.7°). There were no cases of screw tip migration or nonunion, however, there were four cases of excessive screw sliding and six cases of varus angulation at more than 5°.
CHS fixation in lateral decubitus position provides favorable clinical and radiological outcomes. This technique is advisable for regular CHS fixation of intertrochanteric fractures.
使用加压髋螺钉（CHS）进行内固定并将患者置于仰卧位的牵引床是治疗股骨粗隆间骨折的金标准选择；然而，在我们机构，我们采用侧卧位对患者进行这种治疗。在此，对100例连续接受侧卧位CHS内固定的老年（即≥45岁）患者的结果进行分析。
回顾性分析2009年3月至2011年5月期间100例连续接受CHS内固定治疗股骨粗隆间骨折的老年患者。评估临床结果（即Koval评分、Harris髋关节评分 [HHS]）和影像学结果（即骨愈合时间、拉力螺钉滑动量、尖顶距 [TAD]）。
临床评估显示，术后平均Koval评分从1.4降至2.6（范围0 - 5；<0.05）；HHS为85（范围72 - 90）；平均骨愈合时间为5.0（范围2.0 - 8.2）个月。影像学评估显示，前后位平均TAD为6.95（范围1.27 - 14.63）mm；侧位平均TAD为7.26（范围1.20 - 18.43）mm；总平均TAD为14.21（范围2.47 - 28.66）mm；平均拉力螺钉滑动为4.63（范围0 - 44.81）mm；平均成角为内翻0.72°（范围 - 7.6° - 12.7°）。没有螺钉尖端移位或骨不连的病例，然而，有4例拉力螺钉过度滑动和6例内翻成角超过5°的病例。
侧卧位CHS固定提供了良好的临床和影像学结果。该技术适用于股骨粗隆间骨折的常规CHS固定。
