Department of Orthopaedic Surgery, Southern California Permanente Medical Group, San Diego, CA, USA.
Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA.
Perm J. 2020;24. doi: 10.7812/TPP/19.229.
Prior studies regarding indications for long vs short cephalomedullary nails in the treatment of intertrochanteric fractures had limited sample sizes and follow-up, suggesting a need for further investigation.
To evaluate the association between cephalomedullary nail length and outcomes for the treatment of intertrochanteric femur fractures.
Cohort study using Kaiser Permanente's Hip Fracture Registry. A total of 5526 patients who underwent surgical treatment with cephalomedullary nails for an intertrochanteric femur fracture (2009-2014) were identified: 3108 (56.2%) with long nails and 2418 (43.8%) with short nails. Cox proportional hazards model regression was used to evaluate risks of all-cause revision and revision for periprosthetic fracture. Linear regression was used to evaluate operative time, estimated blood loss, and length of stay. Propensity score weights were used in all models to balance nail groups on patient and device characteristics.
All-cause revision surgery.
No association was found in risk of all-cause revision (hazard ratio = 0.75, 95% confidence interval [CI] = 0.48-1.15) or revision for periprosthetic fracture (hazard ratio = 0.59, 95% CI = 0.23-1.48) for long nails compared with short nails. Use of longer nails resulted in 18.80 more minutes of operative time (95% CI = 17.33-20.27 minutes), 41.10 mL more of estimated blood loss (95% CI = 31.71-50.48 mL), and a longer hospitalization (8.4 hours; β = 0.35, 95% CI = 0.12-0.58 hours).
These findings suggest that routine use of short cephalomedullary nails is safe and effective in the treatment of intertrochanteric fractures.
先前有关股骨转子间骨折中长与短股骨近端髓内钉治疗的适应证的研究样本量和随访有限，提示需要进一步研究。
评估股骨近端髓内钉长度与股骨转子间骨折治疗结果之间的关系。
使用 Kaiser Permanente 的髋关节骨折登记处的队列研究。共确定了 5526 例接受股骨近端髓内钉手术治疗的股骨转子间骨折患者（2009-2014 年）：3108 例（56.2%）使用长钉，2418 例（43.8%）使用短钉。使用 Cox 比例风险回归模型评估全因翻修和假体周围骨折翻修的风险。线性回归用于评估手术时间、估计失血量和住院时间。在所有模型中均使用倾向评分权重来平衡患者和器械特征的钉组。
全因翻修手术。
与短钉相比，长钉与全因翻修（风险比=0.75，95%置信区间[CI]：0.48-1.15）或假体周围骨折翻修（风险比=0.59，95%CI：0.23-1.48）的风险无关联。使用较长的钉会导致手术时间延长 18.80 分钟（95%CI：17.33-20.27 分钟），估计失血量增加 41.10 毫升（95%CI：31.71-50.48 毫升），住院时间延长 8.4 小时（β=0.35，95%CI：0.12-0.58 小时）。
这些发现表明，在治疗股骨转子间骨折时，常规使用短股骨近端髓内钉是安全有效的。
