Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Department of Orthopedics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2019 Jul;82(7):584-588. doi: 10.1097/JCMA.0000000000000042.
The cephalomedullary nail is the most common device used to treat unstable intertrochanteric fractures (ITFs) (AO/OTA 31-A2 and A3) in the geriatric population. However, there is lack of radiological parameter to evaluate the entry point; hence, this study reports a new radiological parameter to evaluate the entry point of the nail. Besides, other risk factors were also examined.
A retrospective study on the geriatric population with unstable ITFs was conducted from July 2011 to December 2014. A total of 136 patients were enrolled in this study; they received treatment with Gamma-3 nails (Stryker, Mahwah, NJ, USA) and were followed for at least 1 year. Demographic data, radiological parameters, and side-difference of the distance from the piriformis fossa to the greater trochanteric tubercle in the anteroposterior view (dPG) were compared between the union and failure groups. Student's t test, χ test, and multiple logistic regression were used in the statistical analyses.
The overall failure rate was 13.23% (18 patients). Sex, tip-apex distance (TAD), and dPG were significantly different between the failure and union groups in multivariate analyses. Using a dPG > 6 mm as a reference, patients with a dPG > 6 mm had an odds ratio of 7.64 for failure relative to a dPG < 6 mm.
This study provides additional evidence demonstrating that sex and TAD have significant effects on the outcomes of unstable ITFs after nailing. Moreover, the newly reported radiological parameter, dPG, can be used to predict the failure of ITFs treated using cephalomedullary nails.
在老年人群中，股骨近端髓内钉是治疗不稳定型股骨转子间骨折（AO/OTA 31-A2 和 A3）最常用的装置。然而，目前缺乏评估入钉点的影像学参数，因此本研究报告了一种新的评估钉入点的影像学参数。此外，还检查了其他危险因素。
回顾性分析 2011 年 7 月至 2014 年 12 月收治的老年不稳定型股骨转子间骨折患者。共纳入 136 例患者，采用 Gamma-3 钉（Stryker，Mahwah，NJ，USA）治疗，随访至少 1 年。比较两组患者的人口统计学资料、影像学参数和正位像中外侧梨状窝到大转子结节距离（dPG）的差异。采用 Student's t 检验、卡方检验和多因素逻辑回归进行统计学分析。
总体失败率为 13.23%（18 例）。多因素分析显示，性别、尖顶距（TAD）和 dPG 在失败组和愈合组之间存在显著差异。以 dPG＞6mm 为参考，dPG＞6mm 的患者失败的比值比（OR）为 7.64。
本研究进一步证实，性别和 TAD 对股骨近端髓内钉治疗不稳定型股骨转子间骨折的疗效有显著影响。此外，新报告的影像学参数 dPG 可用于预测股骨近端髓内钉治疗不稳定型股骨转子间骨折的失败。
