未移位股骨颈骨折的植入物定位（IMPO）：与再次手术的关系及 IMPO 评分系统的建立。

Implant positioning (IMPO) in undisplaced femoral neck fractures: Association to reoperation and development of an IMPO scoring system.

机构信息

Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt, Kolding, Denmark.

出版信息

Injury. 2020 Feb;51(2):372-379. doi: 10.1016/j.injury.2019.12.003. Epub 2019 Dec 5.

DOI:10.1016/j.injury.2019.12.003

PMID:31839424

Abstract

INTRODUCTION

This study aims to investigate whether implant positioning is associated to risk of reoperation following internal fixation of undisplaced femoral neck fractures (FNF) with a posterior tilt < 20° in patients > 65 years.

METHOD

Patients were retrieved from the Danish Multidisciplinary Hip Fracture Register in the period 2009-2013. The patients' health records and x-rays were reviewed for age, sex, implant, Charlson Comorbidity Index, mortality, reoperation, fracture classification and implant positioning. X-rays were measured for implant positioning using a pre-existing scoring system (the Schep score) as well as some additional measurements. Primary outcome was reoperation within 2 years. The study included 406 patients, 75% females and the median (range) age was 82 (65-99) years. Odds ratios (OR) are shown with 95% confidence interval.

RESULTS

There were 45 (11%) reoperations. Six measurements were individually associated to risk of reoperation: 1) Distance to inferior calcar < 1 or ≥ 6 mm, OR 2 (1.1-4), 2) Distance to superior cortex 10 mm, OR 2(1.1-5), 3) Tip-head distance < 3 or ≥ 20 mm, OR 2 (1.1-4), 4) Placement in the superior or inferior 15 mm, OR 2 (1.1-5), 5) Placement in the anterior 25 %, OR 6 (1.8-20), 6) Inter-implant angle ≥ 5°, OR 3 (1.4-8). The Schep score had no associated to reoperation, and therefore a new implant positioning (IMPO) score was developed. The IMPO score consists of 6 items; 1 point given for each acceptable implant placement. An IMPO score less than 5 had an increased risk of reoperation; 0-2 points OR 22 (7-71) and OR 5 (2-11) for 3-4 points, compared to a score of 5-6. Among the 207 patients with a score of 5-6, the reoperation frequency was 4%.

CONCLUSIONS

This study identified implant positioning as a predictor to an increased risk of reoperation in undisplaced FNF. The newly developed IMPO score seems promising for identifying risk of reoperation.

摘要

介绍

本研究旨在探讨在 > 65 岁患者中，对于后倾角 < 20°的无移位股骨颈骨折（FNF）行内固定后，植入物的位置是否与再手术风险相关。

方法

从 2009 年至 2013 年，从丹麦多学科髋关节骨折登记处中检索患者。回顾患者的健康记录和 X 射线，以获取年龄、性别、植入物、Charlson 合并症指数、死亡率、再手术、骨折分类和植入物位置。使用现有的评分系统（Schep 评分）以及一些额外的测量方法对 X 射线进行植入物位置测量。主要结果是 2 年内再手术。该研究纳入了 406 名患者，其中 75%为女性，中位（范围）年龄为 82（65-99）岁。比值比（OR）显示了 95%置信区间。

结果

有 45 例（11%）发生了再手术。有 6 项测量结果与再手术风险相关：1）距下骺小于 1 或≥6mm，OR 2（1.1-4）；2）距上皮质 10mm，OR 2（1.1-5）；3）股骨头颈距小于 3 或≥20mm，OR 2（1.1-4）；4）位于上或下 15mm，OR 2（1.1-5）；5）位于前 25%，OR 6（1.8-20）；6）植入物之间的角度≥5°，OR 3（1.4-8）。Schep 评分与再手术无关，因此开发了新的植入物位置（IMPO）评分。IMPO 评分由 6 项组成；每项可接受的植入物位置得 1 分。IMPO 评分小于 5 分，再手术风险增加；0-2 分 OR 22（7-71），3-4 分 OR 5（2-11），与 5-6 分相比。在 207 名评分 5-6 分的患者中，再手术频率为 4%。