Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Orthop Traumatol Surg Res. 2021 Oct;107(6):103006. doi: 10.1016/j.otsr.2021.103006. Epub 2021 Jul 1.
Malalignment is the most important risk factor for fixation failure after intertrochanteric fracture treated with a cephalomedullay nail (CMN). Malalignment continues to occur despite advances in surgical techniques.
We hypothesized that small femur canal size causes intra-operative reduction loss during cephalomedullary nail insertion.
A retrospective study was performed from 2014 to 2017. Patients with acute intertrochanteric fracture implanted with the same sized CMN (Stryker, Mahwah, NJ, USA, diameter: 10mm, length: 170mm, degree 130) were included. Evaluated radiographic parameters included femoral canal size, corrected neck-shaft angle, and calcar reduction.
The study totally included and analyzed the data from 108 patients. Patients with smaller femoral canal size tended to have increased calcar distance according to Pearson's correlation coefficient analysis (r(106)=-0.805, p<0.001). Patients with calcar mal-reduction had higher corrected neck-shaft angle post-operatively. This observed correction tended to be lost during follow up.
Small femoral canal size resulted in poorer reduction quality. Reduction loss during nail insertion may be due to the whole proximal fragment instead of the superolateral femoral neck. Reaming the isthmus before nail insertion or choosing a smaller sized CMN is indicated in this patient population to prevent intra- or post-operative loss of reduction.
III; retrospective study.
在股骨转子间骨折使用股骨近端髓内钉（cephalomedullary nail，CMN）治疗后，对线不良是固定失败的最重要危险因素。尽管手术技术不断进步，但对线不良仍持续发生。
我们假设较小的股骨髓腔大小会导致在髓内钉插入过程中发生术中复位丢失。
回顾性研究于 2014 年至 2017 年进行。纳入接受相同尺寸 CMN（Stryker，Mahwah，NJ，美国，直径 10mm，长度 170mm，角度 130°）植入的急性股骨转子间骨折患者。评估的影像学参数包括股骨髓腔大小、校正颈干角和距骺板距离。
本研究共纳入并分析了 108 例患者的数据。根据 Pearson 相关系数分析，股骨髓腔较小的患者距骺板距离增加（r（106）=-0.805，p<0.001）。距骺板复位不良的患者术后校正颈干角更高。这种观察到的矫正在随访过程中往往会丢失。
较小的股骨髓腔大小导致复位质量较差。在插入髓内钉过程中发生复位丢失可能是由于整个近端骨块而不是股骨颈外侧。在插入髓内钉之前扩髓或选择较小尺寸的 CMN 可用于防止术中或术后复位丢失。
III 级；回顾性研究。
