标准与重建近端交锁螺钉构型用于股骨干骨折顺行髓内钉固定的比较
Comparison of standard versus reconstruction proximal interlocking screw configurations for antegrade intramedullary nail fixation of femoral shaft fractures.
作者信息
Hwang Jihyo, Cannady Darryl F, Nino Samantha, Koval Kenneth J, Langford Joshua R, Parry Joshua A
机构信息
Department of Orthopaedics, Gangnam Sacred Heart Hospital, University of Hallym School of Medicine, Seoul, Republic of Korea.
Department of Orthopaedics, Orlando Health, Orlando, FL, USA.
出版信息
J Clin Orthop Trauma. 2021 Mar 1;17:94-98. doi: 10.1016/j.jcot.2021.02.018. eCollection 2021 Jun.
BACKGROUND
The standard proximal interlocking screw (SS) configuration for antegrade intramedullary nail (IMN) fixation of femoral shaft fractures is lateral to medial or from the greater to less trochanter. Some authors argue for the routine use of the reconstruction screw (RS) configuration (oriented up the femoral neck) instead to prevent femoral neck complications. The purpose of this study was to compare a matched cohort of patients receiving these screw configurations and subsequent complications.
METHODS
A retrospective review of two urban level-one trauma centers identified adults with isolated femoral shaft fractures undergoing antegrade IMN. Patients with RS and SS configurations were matched 1:1 by age, sex, fracture location, and AO classification in order to compare complications.
RESULTS
130 patients with femoral shaft fractures were identified. SS and RS configurations were used in 83 (64%) and 47 (36%) patients. 30 patients from each group were able to be matched for analysis. The RS and SS group did not differ in age, fracture location, AO classification, operative time, or number of distal interlocking screws. The RS group had fewer open fractures and were more likely to have two proximal screws. There were 7 complications, including 5 nonunions and 2 delayed unions, with no detectable difference between RS vs. SS groups (10% vs 13%, Proportional difference -3%, 95% confidence interval (CI) -30 to 14%, p = 0.1). There were no femoral neck complications in the entire cohort of 130 patients. On multivariate analysis none of the variables analyzed were independently associated with the development of complications.
CONCLUSIONS
In this matched cohort of patients with femoral shaft fractures undergoing antegrade IMN fixation, RS and SS configurations were associated with a similar number of complications and no femoral neck complications. The SS configuration remains the standard for antegrade IMN femoral shaft fixation.
LEVEL OF EVIDENCE
Level III, Retrospective cohort study.
背景
股骨干骨折顺行髓内钉固定的标准近端交锁螺钉（SS）构型是从外侧到内侧或从大转子到小转子。一些作者主张常规使用重建螺钉（RS）构型（沿股骨颈方向）以预防股骨颈并发症。本研究的目的是比较接受这两种螺钉构型的配对患者队列及其后续并发症。
方法
对两家市级一级创伤中心进行回顾性研究，确定接受顺行髓内钉治疗的孤立股骨干骨折成人患者。按年龄、性别、骨折部位和AO分类将采用RS和SS构型的患者1:1配对，以比较并发症情况。
结果
共确定130例股骨干骨折患者。83例（64%）患者采用SS构型，47例（36%）患者采用RS构型。每组30例患者能够配对进行分析。RS组和SS组在年龄、骨折部位、AO分类、手术时间或远端交锁螺钉数量方面无差异。RS组开放性骨折较少，且更可能有两枚近端螺钉。共有7例并发症，包括5例骨不连和2例延迟愈合，RS组与SS组之间无明显差异（10%对13%，比例差异-3%，95%置信区间（CI）-30至14%，p = 0.1）。130例患者的整个队列中无股骨颈并发症。多因素分析显示，所分析的变量均与并发症的发生无独立相关性。
结论
在这个接受顺行髓内钉固定的股骨干骨折配对患者队列中，RS和SS构型的并发症数量相似，且无股骨颈并发症。SS构型仍然是股骨干顺行髓内钉固定的标准。
证据水平
III级，回顾性队列研究。
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