Orthopedic Trauma Division, Trauma Center, Gachon University College of Medicine, Namdong-gu, Incheon, Republic of Korea.
Department of Orthopedic Surgery, School of Medicine, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do Province, Republic of Korea.
Injury. 2022 Apr;53(4):1477-1483. doi: 10.1016/j.injury.2022.01.038. Epub 2022 Jan 25.
Intramedullary nailing (IMN), which is a common method for treating subtrochanteric fractures, is conducted as cephalomedullary (CMN) or reconstruction (RCN) nailing. Numerous studies have reported the effectiveness of CMN, which requires a shorter surgery time and provides stronger fixation strength with blade-type devices. However, the radiographic and clinical outcomes of the use of CMN and RCN in elderly patients aged ≥65 years have not been compared yet. This study aimed to investigate whether CMN offers superior outcomes over RCN in the treatment of subtrochanteric fractures in elderly patients.
This retrospective study included 60 elderly patients (17 men and 43 women; mean age: 74.9 years) diagnosed with subtrochanteric fractures and treated with IMN with helical blade CMN (CMN group: 30 patients) or RCN (RCN group: 30 patients) between January 2013 and December 2018 with at least 1 year of follow-up period. Radiologic outcomes were evaluated based on the postoperative state of alignment and the achievement and timing of bony union at the final follow-up. Clinical outcomes were evaluated using the Merle d'Aubigné-Postel score. Radiologic and clinical outcomes in the two groups were compared and analyzed, and the occurrence of complications was examined.
The difference in malalignment between the two groups was not significant; however, the RCN group achieved more effective reduction. At the final follow-up, bony union was achieved within 18.9 weeks, on average, in 28 patients in the CMN group and within 21.6 weeks, on average, in 27 patients in the RCN group. Twenty patients in the CMN group and 26 in the RCN group showed good or better results according to the Merle d'Aubigné-Postel score. No significant differences were found for any of the parameters.
In the treatment of difficult subtrochanteric fractures in elderly patients, RCN can provide excellent reduction and strong fixation similar to CMN and can result in outstanding clinical and radiologic outcomes.
髓内钉（IMN）是治疗转子下骨折的常用方法，可进行顺行髓内钉（CMN）或重建髓内钉（RCN）固定。大量研究报道了 CMN 的有效性，CMN 手术时间更短，且刀片式设备可提供更强的固定强度。然而，在≥65 岁的老年患者中，CMN 和 RCN 的放射学和临床结果尚未进行比较。本研究旨在探讨 CMN 在治疗老年转子下骨折方面是否优于 RCN。
本回顾性研究纳入了 2013 年 1 月至 2018 年 12 月期间采用螺旋刀片 CMN（CMN 组：30 例）或 RCN（RCN 组：30 例）行 IMN 治疗的 60 例老年（男 17 例，女 43 例；平均年龄：74.9 岁）转子下骨折患者，所有患者均获得至少 1 年随访。根据最终随访时的对线情况以及骨愈合的获得和时间来评估放射学结果。采用 Merle d'Aubigné-Postel 评分评估临床结果。比较和分析两组的放射学和临床结果，并检查并发症的发生情况。
两组的对线不良差异无统计学意义；但 RCN 组获得了更有效的复位。CMN 组有 28 例患者在平均 18.9 周、RCN 组有 27 例患者在平均 21.6 周达到骨性愈合。CMN 组有 20 例患者和 RCN 组有 26 例患者根据 Merle d'Aubigné-Postel 评分获得了良好或更好的结果。所有参数均无显著差异。
在治疗老年困难转子下骨折时，RCN 可提供与 CMN 相似的出色复位和牢固固定，从而获得出色的临床和放射学结果。
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