Kim Byung-Kook, Jung Suk Han, Han Donghun
Department of Orthopaedic Surgery, CHA Gumi Medical Center, CHA University School of Medicine, Gumi, Korea.
Hip Pelvis. 2022 Mar;34(1):18-24. doi: 10.5371/hp.2022.34.1.18. Epub 2022 Mar 7.
The aim of this study was to determine whether there is a correlation between the type and stability of intertrochanteric fractures caused by low-energy trauma and gluteus muscle volume.
A total of 205 elderly (>65 years) patients with intertrochanteric fractures caused by low-energy trauma treated from January 2018 to December 2020 were included in this study. The mean age of patients was 81.24 years (range, 65-100 years). Fractures were classified according to the Jensen modification of the Evans classification. The cross-sectional area of the contralateral gluteus muscle (minimus, medius, and maximus) was measured in preoperative axial computed tomography slices. An analysis and comparison of age, body mass index (BMI), weight, height, and the gluteus muscle area in each fracture type group was performed.
In the uni-variable analysis, statistically significant taller height was observed in patients in the stable intertrochanteric fracture (modified Evans 1 and 2) group compared with those in the unstable intertrochanteric fracture (modified Evans 3, 4, and 5) group (<0.05). In addition, significantly higher BMI-adjusted gluteus muscle area (gluteus muscle area/BMI) was observed for the stable intertrochanteric fracture group compared with the unstable intertrochanteric fracture group except for the BMI-adjusted gluteus minimus area (=0.112). In multivariable analysis, only the BMI-adjusted gluteus maximus (=0.042) and total gluteus areas (=0.035) were significantly higher in the stable group.
Gluteal muscularity around the hip, especially the gluteus maximus, had a significant effect on the stability of intertrochanteric fractures.
本研究旨在确定低能量创伤所致粗隆间骨折的类型与稳定性和臀肌体积之间是否存在相关性。
本研究纳入了2018年1月至2020年12月期间接受治疗的205例因低能量创伤导致粗隆间骨折的老年（>65岁）患者。患者的平均年龄为81.24岁（范围65 - 100岁）。骨折根据Evans分类的Jensen改良法进行分类。在术前轴向计算机断层扫描切片中测量对侧臀肌（臀小肌、臀中肌和臀大肌）的横截面积。对各骨折类型组的年龄、体重指数（BMI）、体重、身高和臀肌面积进行分析和比较。
在单变量分析中，与不稳定型粗隆间骨折（改良Evans 3、4和5型）组相比，稳定型粗隆间骨折（改良Evans 1和2型）组患者的身高在统计学上显著更高（<0.05）。此外，除了BMI调整后的臀小肌面积（=0.112）外，稳定型粗隆间骨折组的BMI调整后臀肌面积（臀肌面积/BMI）显著高于不稳定型粗隆间骨折组。在多变量分析中，仅稳定组的BMI调整后臀大肌（=0.042）和总臀肌面积（=0.035）显著更高。
髋部周围的臀肌，尤其是臀大肌，对粗隆间骨折的稳定性有显著影响。
