使用带与不带远端交锁螺钉的股骨近端髓内钉治疗股骨转子间骨折的对比研究

Comparative study of intertrochanteric fracture fixation using proximal femoral nail with and without distal interlocking screws.

作者信息

Lil Nadeem A, Makwana Vipul R, Patel Tirth D, Patel Arjav R

机构信息

Department of Orthopaedics, NHL Medical College, Ahmedabad 380006, Gujarat, India.

出版信息

World J Orthop. 2022 Mar 18;13(3):267-277. doi: 10.5312/wjo.v13.i3.267.

DOI:10.5312/wjo.v13.i3.267

PMID:35317250

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8935330/

Abstract

BACKGROUND

Intertrochanteric (IT) fracture is one of the most common fractures seen in an orthopaedic practice. Proximal femoral nailing (PFN) is a common modality of fixing IT femur fracture. We retrospectively studied whether a PFN with two proximal lag screws can be done without distal interlocking screws in the 31-A1 and 31-A2 fracture patterns according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) guidelines for IT femur fractures.

AIM

To compare the outcomes of IT fractures (AO/OTA 31-A1 and 31-A2) treated by PFN with and without distal interlocking screws.

METHODS

We carried out a retrospective study of 140 patients in a tertiary care centre who had AO/OTA type 31-A1 and 31-A2 IT fractures. We divided the patients into two groups, in which one of the groups received distal interlocking screws (group 1) and the other group did not (group 2). The subjects were followed up for a mean period of 14 mo and assessed for radiological union time, fracture site collapse, mechanical stability of implant, and complications associated with the PFN with distal interlocking and without distal interlocking. Then, the results were compared.

RESULTS

PFN without distal interlocking screws has several advantages and gives better results over PFN with distal interlocking screws in the AO/OTA 31-A2 fracture pattern. However, similar results were observed in both groups with the fracture pattern AO/OTA 31-A1. In patients with fracture pattern AO/OTA 31-A2 treated by PFN without distal interlocking screws, there were minimal proximal lock-related complications and no risk of distal interlock-related complications. The operative time, IITV radiation time and time to radiological union were reduced. These patients also had better rotational alignment of the proximal femur, and the anatomy of the proximal femur was well maintained. It was also noted that in the cases where distal interlocking was performed, there was a gradual decrease in neck shaft angle, which led to varus collapse and failure of bone-implant construct in 21.40%.

CONCLUSION

In fracture pattern AO/OTA 31-A2, PFN without distal interlocking had better results and less complications than PFN with distal interlocking.

摘要

背景

转子间骨折是骨科临床中最常见的骨折之一。股骨近端髓内钉（PFN）是治疗股骨转子间骨折的常用方法。我们根据 Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association（AO/OTA）股骨转子间骨折指南，回顾性研究了对于 31 - A1 和 31 - A2 骨折类型，不使用远端锁定螺钉的双近端拉力螺钉 PFN 是否可行。

目的

比较使用和不使用远端锁定螺钉的 PFN 治疗转子间骨折（AO/OTA 31 - A1 和 31 - A2）的疗效。

方法

我们在一家三级医疗中心对 140 例患有 AO/OTA 31 - A1 和 31 - A2 型转子间骨折的患者进行了回顾性研究。我们将患者分为两组，其中一组接受远端锁定螺钉（第 1 组），另一组不接受（第 2 组）。对受试者进行平均 14 个月的随访，并评估放射学愈合时间、骨折部位塌陷、植入物的机械稳定性以及与带远端锁定和不带远端锁定的 PFN 相关的并发症。然后，比较结果。

结果

在 AO/OTA 31 - A2 骨折类型中，不使用远端锁定螺钉的 PFN 具有若干优势，且比使用远端锁定螺钉的 PFN 疗效更好。然而，在 AO/OTA 31 - A1 骨折类型中，两组观察到相似的结果。在接受不使用远端锁定螺钉的 PFN 治疗的 AO/OTA 31 - A2 骨折患者中，近端锁定相关并发症极少，且无远端锁定相关并发症风险。手术时间、术中透视时间和放射学愈合时间缩短。这些患者股骨近端的旋转对线也更好，股骨近端的解剖结构得到良好维持。还注意到，在进行远端锁定的病例中，颈干角逐渐减小，导致 21.40%的病例出现内翻塌陷和骨 - 植入物结构失败。