Würdemann Franka S, Poolman Rudolf W, Krijnen Pieta, Bzovsky Sofia, Sprague Sheila, Kaptein Bart L, Hegeman Johannes H, Schemitsch Emil H, Bhandari Mohit, Swiontkowski Marc, Schipper Inger B
aDepartment of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands; bDepartment of Orthopaedic and Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands; cDivision of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON, Canada; dDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; eDepartment of Trauma Surgery, Ziekenhuisgroep Twente, Almelo-Hengelo, The Netherlands; fDepartment of Surgery, University of Western Ontario, London, ON, Canada; and gDepartment of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN.
J Orthop Trauma. 2020 Nov;34 Suppl 3:S76-S80. doi: 10.1097/BOT.0000000000001934.
This study evaluated whether patients with a left-sided femoral neck fracture (FNF) treated with a sliding hip screw (SHS) had a higher implant failure rate than patients treated for a right-sided FNF. This was performed to determine the clinical relevance of the clockwise rotational torque of the femoral neck lag screw in a SHS, in relation to the rotational stability of left and right-sided FNFs after fixation.
Data were derived from the FAITH trial and Dutch Hip Fracture Audit (DHFA). Patients with a FNF, aged ≥50, treated with a SHS, with at least 3-month follow-up data available, were included. Implant failure was analyzed in a multivariable logistic regression model adjusted for age, sex, fracture displacement, prefracture living setting and functional mobility, and American Society for Anesthesiologists Class.
One thousand seven hundred fifty patients were included, of which 944 (53.9%) had a left-sided and 806 (46.1%) a right-sided FNF. Implant failure occurred in 60 cases (3.4%), of which 31 were left-sided and 29 right-sided. No association between fracture side and implant failure was found [odds ratio (OR) for left vs. right 0.89, 95% confidence interval (CI) 0.52-1.52]. Female sex (OR 3.02, CI: 1.62-6.10), using a mobility aid (OR 2.02, CI 1.01-3.96) and a displaced fracture (OR 2.51, CI: 1.44-4.42), were associated with implant failure.
This study could not substantiate the hypothesis that the biomechanics of the clockwise screw rotation of the SHS contributes to an increased risk of implant failure in left-sided FNFs compared with right-sided fractures.
Therapeutic Level II.See Instructions for Authors for a complete description of levels of evidence.
本研究评估了采用滑动髋螺钉（SHS）治疗左侧股骨颈骨折（FNF）的患者与治疗右侧FNF的患者相比，植入物失败率是否更高。这样做是为了确定SHS中股骨颈拉力螺钉顺时针旋转扭矩与固定后左侧和右侧FNF旋转稳定性的临床相关性。
数据来源于FAITH试验和荷兰髋部骨折审计（DHFA）。纳入年龄≥50岁、接受SHS治疗且有至少3个月随访数据的FNF患者。在多变量逻辑回归模型中分析植入物失败情况，该模型对年龄、性别、骨折移位、骨折前生活环境和功能活动能力以及美国麻醉医师协会分级进行了调整。
共纳入1750例患者，其中944例（53.9%）为左侧FNF，806例（46.1%）为右侧FNF。60例（3.4%）发生植入物失败，其中31例为左侧，29例为右侧。未发现骨折侧与植入物失败之间存在关联[左侧与右侧的比值比（OR）为0.89，95%置信区间（CI）为0.52 - 1.52]。女性（OR 3.02，CI：1.62 - 6.10）、使用助行器（OR 2.02，CI 1.01 - 3.96）和移位骨折（OR 2.51，CI：1.44 - 4.42）与植入物失败相关。
本研究无法证实以下假设：与右侧骨折相比，SHS顺时针螺钉旋转的生物力学导致左侧FNF植入物失败风险增加。
治疗性II级。有关证据水平的完整描述，请参阅作者须知。
