Department of Orthopedics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Sciences, Xiangyang, China.
Department of Nephrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
Ann Palliat Med. 2021 Dec;10(12):12857-12866. doi: 10.21037/apm-21-3635.
Intertrochanteric fracture of femur is a common fracture in the elderly, and the number of intramedullary nails used to manage intertrochanteric fractures has steadily increased, but the evidence for the clinical efficacy of this practice is lacking. The present study retrospectively compared the clinical outcomes and imaging features of patients with unstable intertrochanteric hip fractures treated with traditional extramedullary hip screws (AO/OTA 31-A2) and patients with the same injury treated with newer intramedullary screws.
Lower limb measurement (LLM) for the main results of the hip-specific tools, functional independence measure (FIM), and "timed up and go" (TUG) to test the scale and timing of the 2-minute walk test were used as secondary tools for clinical outcomes. Other detailed radiological parameters to evaluate the fracture movement, such as heterotopic ossification, and implant failure, were also recorded.
There were no significant differences between the intramedullary and extramedullary treatment groups in terms of the measures acquired by the primary or secondary clinical outcome tools (P>0.05), but the radiographic parameters favored the intramedullary treatment group as it showed reduced femoral neck shortening.
Although treatment with intramedullary nailing resulted in better radiographic assessment results, this did not translate into better functional recovery outcomes.
股骨转子间骨折是老年人常见的骨折，用于治疗转子间骨折的髓内钉数量稳步增加，但这种治疗方法的临床疗效证据不足。本研究回顾性比较了传统髓外髋螺钉（AO/OTA 31-A2）治疗不稳定型转子间髋部骨折患者和接受相同损伤的新型髓内钉治疗患者的临床结果和影像学特征。
采用髋关节专用工具的下肢测量（LLM）、功能独立性测量（FIM）和“计时起立行走”（TUG）测试 2 分钟步行测试的量表和时间作为临床结果的次要工具。还记录了其他详细的评估骨折移位的影像学参数，如异位骨化和植入物失败。
在主要临床结果工具或次要临床结果工具获得的测量值方面，髓内和髓外治疗组之间没有显著差异（P>0.05），但影像学参数倾向于髓内治疗组，因为髓内治疗组股骨颈缩短减少。
尽管髓内钉治疗的影像学评估结果更好，但这并没有转化为更好的功能恢复结果。
