Nie Shaobo, Li Ming, Li Jiantao, Zhao Yanpeng, Cui Xiang, Xu Gaoxiang, Zhang Licheng, Zhang Wei, Tang Peifu
Department of Orthopedics, The First Medical Centre, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, People's Republic of China.
Ther Clin Risk Manag. 2020 Jun 18;16:523-530. doi: 10.2147/TCRM.S252214. eCollection 2020.
Anterior cortical impingement is a common phenomenon after intramedullary fixation in Asian patients with intertrochanteric fractures. It may cause thigh pain and even fracture of the femoral shaft, which may seriously affect postoperative rehabilitation and limb function of patients. However, little was known about risk factors for anterior cortical impingement in Chinese elderly after intramedullary nailing. Hence, the aim of this study was to certify the risk factors for anterior cortical impingement treated with intramedullary nails of intertrochanteric fracture, hoping to provide suggestions for surgical treatment.
A retrospective consecutive series of 94 patients who had been diagnosed as intertrochanteric fracture at our institution was included from January 2019 to November 2019. All patients were treated with intramedullary fixation and followed up for at least 6 months. Demographic, surgical and anesthesiologic information, as well as radiographic data and complications were collected and reviewed.
The ratio of anterior cortical impingement is significantly higher in female patients than that of males (80.4% vs 18.6%, =0.041). Higher incidence of anterior cortical impingement was found in the longer intramedullary nail group, especially in females. Gender (as a female patient) and length of nail were significant risk factors for anterior cortical impingement in intertrochanteric fracture patients treated with intramedullary nail (OR =2.662, 95% CI =1.010-7.018, =0.447; OR =1.047, 95% CI =1.016-1.079, respectively). The length of nail was a risk factor for anterior cortical impingement in female intertrochanteric fracture patients treated with intramedullary nail (OR =1.051, 95% CI =1.015-1.089).
Elderly female patients with intertrochanteric fractures treated with intramedullary nails had a higher incidence of anterior cortical impingement. The length of short intramedullary nail is a risk factor for anterior cortical impingement. Patients with anterior cortical impingement may suffer serious complications.
在前外侧转子间骨折的亚洲患者中，髓内固定术后前皮质撞击是一种常见现象。它可能导致大腿疼痛甚至股骨干骨折，这可能严重影响患者的术后康复和肢体功能。然而，对于中国老年患者髓内钉固定术后前皮质撞击的危险因素知之甚少。因此，本研究的目的是确定转子间骨折髓内钉治疗前皮质撞击的危险因素，希望为手术治疗提供建议。
纳入2019年1月至2019年11月在我院确诊为转子间骨折的94例连续回顾性患者。所有患者均接受髓内固定治疗并随访至少6个月。收集并回顾人口统计学、手术和麻醉信息，以及影像学数据和并发症。
女性患者前皮质撞击的比例显著高于男性（80.4%对18.6%，P = 0.041）。在较长髓内钉组中发现前皮质撞击的发生率较高，尤其是在女性中。性别（女性患者）和髓内钉长度是转子间骨折髓内钉治疗患者前皮质撞击的显著危险因素（OR = 2.662，95%CI = 1.010 - 7.018，P = 0.447；OR = 1.047，95%CI = 1.016 - 1.079）。髓内钉长度是女性转子间骨折髓内钉治疗患者前皮质撞击的危险因素（OR = 1.051，95%CI = 1.015 - 1.089）。
老年女性转子间骨折患者髓内钉治疗后前皮质撞击的发生率较高。短髓内钉长度是前皮质撞击的危险因素。前皮质撞击患者可能会出现严重并发症。
