Yang Yun-Fa, Huang Jian-Wen, Gao Xiao-Sheng
Department of Orthopaedic Surgery, Guangzhou First People's Hospital, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China.
Geriatr Orthop Surg Rehabil. 2022 Mar 29;13:21514593221083820. doi: 10.1177/21514593221083820. eCollection 2022.
To discover the key evaluation tool of the cephalic fixation position for predicting implant failures in geriatric intertrochanteric fracture (ITF) patients treated with internal fixations after achieving an acceptable reduction.
We measured the geriatric ITF patients undergoing single-screw cephalomedullary nailing (CMN) fixation surgery after obtaining the acceptable reduction (including anatomical reduction and positive medial cortex support reduction) in our treatment group between September 2016 and March 2020 by using four kinds of cephalic fixation position evaluation tools including Cleveland zone system, Parker's ratio index, tip-apex distance (TAD), calcar-referenced TAD (CalTAD), and analyzed which were the key evaluation tools for measurement of cephalic fixation position for prediction of implant failures in geriatric ITF patients with internal fixations.
Seventy-four ITF patients treated with single-screw CMN fixation after obtaining the acceptable reduction were enrolled in this study. Of the 74 patients, nine cases were observed with implant failures. There were six cases of cut-out and three of pending cut-out. We found that TAD (odds ratio (OR)=1.149; 95% confidence interval (CI), 1.00-1.32; P=.046) and CalTAD (OR=1.140; 95% CI, 1.00-1.30; P=.037) were risk factors for implant failures by univariate analysis, while only CalTAD (OR=1.200; 95% CI, 1.032-1.395; P=.018) was the independent risk factor for implant failures by multivariate analysis. The Kappa coefficient (κ) of CalTAD was .976 (95% CI, .966-.984) by ICC analysis. The ROC analysis showed that the best cut-off value of CalTAD was 23.76 mm with a sensitivity of 77.8% and specificity of 72.3% (area under the curve, AUC =.775; P = .001).
CalTAD is the key evaluation tool for measurement of cephalic fixation position for predicting implant failures in geriatric ITF patients treated with single-screw CMN after obtaining the acceptable reduction.
在老年股骨转子间骨折（ITF）患者接受内固定治疗且复位良好后，探寻预测植入物失败的关键头钉固定位置评估工具。
在2016年9月至2020年3月期间，我们对治疗组中接受单枚螺钉股骨近端髓内钉（CMN）固定手术且复位良好（包括解剖复位和内侧皮质支撑复位阳性）的老年ITF患者，使用四种头钉固定位置评估工具进行测量，这四种工具包括克利夫兰分区系统、帕克比率指数、尖顶距（TAD）、参照股骨距的TAD（CalTAD），并分析哪些是预测老年ITF内固定患者植入物失败的头钉固定位置测量的关键评估工具。
本研究纳入了74例接受单枚螺钉CMN固定且复位良好的ITF患者。在这74例患者中，观察到9例植入物失败。其中有6例穿出和3例即将穿出。单因素分析发现，TAD（优势比（OR）=1.149；95%置信区间（CI），1.00 - 1.32；P = 0.046）和CalTAD（OR = 1.140；95% CI，1.00 - 1.30；P = 0.037）是植入物失败的危险因素，而多因素分析显示只有CalTAD（OR = 1.200；95% CI，1.032 - 1.395；P = 0.018）是植入物失败的独立危险因素。通过组内相关系数（ICC）分析，CalTAD的Kappa系数（κ）为0.976（95% CI，0.966 - 0.984）。ROC分析显示，CalTAD的最佳截断值为23.76 mm，灵敏度为77.8%，特异度为72.3%（曲线下面积，AUC = 0.775；P = 0.001）。
对于接受单枚螺钉CMN治疗且复位良好的老年ITF患者，CalTAD是预测植入物失败的头钉固定位置测量的关键评估工具。
