Zhao Yifeng, Zhu Fenghua, Chang Qinghua, Liu Jiheng, Zhang Rui, Song Fuqiang, Chu Fenglong, Zai Qingshu, Guo Wei, Yang Xianwei, Shi Qiang, Zhang Feng, Wang Haibin, Jiang Zhen
Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China.
Department of Orthopedics, Jiaxiang People's Hospital, Jiaxiang Shandong, 272400, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Sep 15;35(9):1086-1092. doi: 10.7507/1002-1892.202103233.
To formulate the classification criteria of femoral intertrochanteric fractures based on irreducibility or not in order to predict the difficulty of fracture recovery.
A clinical data of 244 patients with closed femoral intertrochanteric fractures admitted between January 2017 and March 2020 was retrospectively analyzed. There were 116 males and 128 females with an average age of 77.9 years (range, 45-100 years). The cause of injury included falling in 190 cases, traffic accident in 36 cases, smashing in 13 cases, and falling from height in 5 cases. The time from injury to operation was 1-14 days (mean, 3.6 days). According toAO/Orthopaedic Trauma Association (AO/OTA) classification, the fractures were classified as type 31-A1 in 38 cases, type 31-A2 in 160 cases, and type 31-A3 in 46 cases. According to whether the recovery difficulty occurred after intraoperative closed traction reset, the patients were divided into reducible-group and irreducible-group; combined with the literature and preoperative imaging data of two groups, the classification criteria of femoral intertrochanteric fractures was formulated based on the irreducibility or not. The 244 fractures were classified by the doctors who did not attend the operation according to the classification criteria, predicted the difficulty of fracture reduction, and compared with the actual intraoperative reduction situation.
The 244 patients were divided into reducible-group ( =164, 67.21%) and irreducible-group ( =80, 32.79%) according to the intraoperative difficulty of reduction. Comparing the imaging data and characteristics of the two groups, and formulating the classification criteria of femoral intertrochanteric fractures based on irreducibility or not, the fractures were mainly divided into two categories of irreducibility and reducibility. The fractures of irreducibility category was divided into typesⅠ-Ⅴ, among which type Ⅲ was divided into subtypes 1-4; the fractures of reducibility category was divided into typesⅠand Ⅱ. Compared with the actual intraoperative evaluation results, the total accuracy rate of the doctors who did not attend the operation was 81.15% (198/244) based on the classification criteria of femoral intertrochanteric fractures. The accuracy rate of irreducibility category was 65.74% (71/108), and the reducibility category was 93.38% (127/136). All patients were followed up 13-25 months, with an average of 17.6 months. All fractures healed except 2 cases died of infection.
The classification criteria of femoral intertrochanteric fractures based on irreducibility or not can accurately predict the reducible cases preoperatively, and most of the irreducible cases can be correctly predicted in a wider way. But the classification criteria still need to be further improved and supplemented.
制定基于能否复位的股骨转子间骨折分类标准，以预测骨折复位的难度。
回顾性分析2017年1月至2020年3月收治的244例闭合性股骨转子间骨折患者的临床资料。男性116例，女性128例，平均年龄77.9岁（范围45 - 100岁）。受伤原因包括跌倒190例、交通事故36例、砸伤13例、高处坠落5例。受伤至手术时间为1 - 14天（平均3.6天）。按照AO/骨科创伤协会（AO/OTA）分类，38例为31 - A1型骨折，160例为31 - A2型骨折，46例为31 - A3型骨折。根据术中闭合牵引复位后是否出现复位困难，将患者分为可复位组和不可复位组；结合两组的文献及术前影像学资料，制定基于能否复位的股骨转子间骨折分类标准。由未参与手术的医生依据分类标准对244例骨折进行分类，预测骨折复位难度，并与术中实际复位情况进行比较。
根据术中复位难度，244例患者分为可复位组（n = 164，67.21%）和不可复位组（n = 80，32.79%）。比较两组的影像学资料及特征，制定基于能否复位的股骨转子间骨折分类标准，骨折主要分为不可复位和可复位两大类。不可复位类骨折分为Ⅰ - Ⅴ型，其中Ⅲ型又分为1 - 4亚型；可复位类骨折分为Ⅰ型和Ⅱ型。与术中实际评估结果比较，未参与手术的医生依据股骨转子间骨折分类标准的总准确率为81.15%（198/244）。不可复位类的准确率为65.74%（71/108），可复位类为93.38%（127/136）。所有患者均随访13 - 25个月，平均17.6个月。除2例因感染死亡外，所有骨折均愈合。
基于能否复位的股骨转子间骨折分类标准可在术前准确预测可复位病例，且能较广泛地正确预测大多数不可复位病例。但该分类标准仍需进一步完善和补充。
