Shon Oog-Jin, Choi Chang Hyun, Park Chan Ho
Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea.
Hip Pelvis. 2021 Sep;33(3):154-161. doi: 10.5371/hp.2021.33.3.154. Epub 2021 Sep 6.
Although proximal femoral nail antirotation (PFNA; Synthes, Switzerland) has demonstrated satisfactory results when used for the treatment of intertrochanteric fractures, mechanical complications may occur. To better quantify the risk of mechanical complications when proximal femoral nail antirotation is used to treat intertrochanteric fractures, this study aimed to: (1) characterize the frequency of mechanical complications and extent of blade sliding and their correlation with reduction quality and (2) identify factors associated with mechanical complications.
A review of medical records from 93 patients treated for intertrochanteric fractures with a minimum of 6-months of follow-up between February 2014 and February 2019 was conducted. Blade position was evaluated using Tip-apex distance (TAD) and Cleveland index. The extent of blade sliding was evaluated using the adjusted Doppelt's method for intramedullary nailing. Individuals were classified as having or not having mechanical complications, and reduction quality and radiologic outcomes were compared between the two groups.
Mechanical complications occurred in 12 of 94 hips (12.8%), with 11 out of 12 being from the intramedullary reduction group. There was no significant difference in TAD between groups; however, there were significant differences were noted in Cleveland index, AO/OTA classification, reduction quality and extent of blade sliding. The mean blade sliding distance was 1.17 mm (anatomical group), 3.28 mm (extramedullary group), and 6.11 mm (intramedullary group), respectively (<0.001). Data revealed that blade sliding was an associated factor for mechanical complications (odds ratio 1.25, 95% confidence interval 1.03-1.51).
The extent of blade sliding determined using the adjusted Doppelt's method was significantly associated with mechanical complications suggesting that prevention of excessive sliding through proper intraoperative reduction is important to help achieve satisfactory treatment outcomes.
尽管股骨近端防旋髓内钉（PFNA；瑞士辛迪思公司）用于治疗股骨转子间骨折时已显示出令人满意的效果，但仍可能发生机械并发症。为了更好地量化使用股骨近端防旋髓内钉治疗股骨转子间骨折时发生机械并发症的风险，本研究旨在：（1）描述机械并发症的发生频率、刀片滑动程度及其与复位质量的相关性，以及（2）确定与机械并发症相关的因素。
回顾性分析2014年2月至2019年2月期间93例接受股骨转子间骨折治疗且随访至少6个月的患者的病历。使用尖顶距（TAD）和克利夫兰指数评估刀片位置。采用改良的多佩尔特髓内钉置入法评估刀片滑动程度。将患者分为发生或未发生机械并发症两组，并比较两组间的复位质量和影像学结果。
94髋中有12髋（12.8%）发生机械并发症，其中12例中有11例来自髓内复位组。两组间TAD无显著差异；然而，克利夫兰指数、AO/OTA分类、复位质量和刀片滑动程度存在显著差异。平均刀片滑动距离分别为1.17mm（解剖组）、3.28mm（髓外组）和6.11mm（髓内组）（P<0.001）。数据显示，刀片滑动是机械并发症的相关因素（比值比1.25，95%置信区间1.03-1.51）。
采用改良的多佩尔特法测定的刀片滑动程度与机械并发症显著相关，提示术中通过适当复位防止过度滑动对于获得满意的治疗效果很重要。
