Karayiannis Paul, James Andrew
Ulster Hospital, Belfast, Northern Ireland, UK.
, 221 Mealough Road, Lisburn, BT27 5LE, Northern Ireland, UK.
Eur J Trauma Emerg Surg. 2020 Oct;46(5):969-975. doi: 10.1007/s00068-018-01071-4. Epub 2019 Jan 5.
To assess the potential impact of using cerclage cables or wires when undertaking fixation of unstable intertrochanteric and subtrochanteric fractures.
Patients were identified from a validated hospital database which included patients from all trauma units within Northern Ireland from 2008 to 2015. The primary outcome measure was return to theatre for any reason. Secondary outcome measures included quality of reduction, tip-apex distance, length of stay, mortality at 3 and 12 months and functional outcomes assessed by Barthel Index and mobility.
465 patients were included (157 in the cerclage/wire group and 308 without). Mean age of 79.6 years, with 330 females and 135 males. There was no statistical difference between the groups in relation to baseline demographics and risk factors for complications. 24 patients required further surgery, 13 (8.3%) in the cerclage group and 11 (3.6%) in those without (p < 0.03). Cabling of intertrochanteric fractures resulted in further surgery in 9.1% versus 3.4% without. Quality of reduction was improved in the cerclage group (p < 0.01), however improvements were less noticeable in intertrochanteric fractures (32.3% classified as good) compared to subtrochanteric fractures (52.4% good). Length of stay was longer in the cerclage group (p < 0.01). No differences were noted in mortality, Barthel score or mobility at 3 and 12 months.
Cerclage cables/wires can augment fixation in subtrochanteric fractures with potential benefits including improving quality of reduction. Evidence for their use in intertrochanteric fractures is much more contentious and we would advise they only be used where a definite improvement in reduction can be obtained with the minimum number possible.
评估在固定不稳定型转子间和转子下骨折时使用环扎钢缆或钢丝的潜在影响。
从一个经过验证的医院数据库中识别患者，该数据库包括2008年至2015年北爱尔兰所有创伤科的患者。主要结局指标是因任何原因返回手术室。次要结局指标包括复位质量、尖顶距、住院时间、3个月和12个月时的死亡率以及通过巴氏指数和活动能力评估的功能结局。
纳入465例患者（环扎/钢丝组157例，未使用组308例）。平均年龄79.6岁，女性330例，男性135例。两组在基线人口统计学和并发症危险因素方面无统计学差异。24例患者需要进一步手术，环扎组13例（8.3%），未使用组11例（3.6%）（p<0.03）。转子间骨折使用环扎导致再次手术的比例为9.1%，未使用环扎的为3.4%。环扎组复位质量得到改善（p<0.01），然而与转子下骨折（52.4%为良好）相比，转子间骨折（32.3%为良好）的改善不太明显。环扎组住院时间更长（p<0.01）。在3个月和12个月时，死亡率、巴氏评分或活动能力方面未发现差异。
环扎钢缆/钢丝可增强转子下骨折的固定，潜在益处包括提高复位质量。其在转子间骨折中的使用证据更具争议性，我们建议仅在能以最少数量获得明确复位改善的情况下使用。
