Department of Orthopedics and Traumatology, Erzincan Binali Yıldırım University Facult of Medicine, Erzincan-Turkey.
Department of Orthopedics and Traumatology, Bitlis State Hospital, Bitlis-Turkey.
Ulus Travma Acil Cerrahi Derg. 2022 May;28(5):668-677. doi: 10.14744/tjtes.2020.80733.
The aim of this study to compare three cephalomedullary nails (CMNs) with different designs in terms of complica-tion, reoperation, implant failure, mortality rates, and functional outcomes in the treatment of unstable intertrochanteric fractures (UIFs).
This retrospective study included patients with UIFs (AO/OTA type 31-A2 and 31-A3) who were treated with one of these CMNs (74 patients with Talon-PFN, 70 patients with PFN-III, and 69 patients with Intertan) between October 2014 and October 2018.
A total of 213 patients (122 females and 91 males) with a mean age of 81.0±9.3 years have participated in this study. The mean follow-up time was 26.1±6.3 months. Malfixation was the most common complication and the most common reason of reop-eration for each type of CMN. Complication and reoperation rates, post-operative functional status, mean union times, and overall mortality rates were similar between groups. Mean operation/fluoroscopy time and mean blood loss were low in the Talon-PFN group, whereas the highest means of these parameters were in the PFN-III group. There were six (8.2%) implant failures in the Talon-PFN group and one (1.5%) in PFN-III group. No implant failure was seen in the Intertan group. The highest rate (58.6%) of anatomic reduc-tion was detected in PFN-III group.
Our study results showed that each implant type had its own advantages and disadvantages in the treatment of UIFs with similar functional and reoperation outcomes. Intertan was advantageous with its absence of implant failures. Talon-PFN decreased the operation/fluoroscopy time and intraoperative blood loss but had the highest implant failure rate. There was a need for more anatomic reduction to centralize two separate parallel lag screws in the femoral neck in PFN-III group, and that costs operation/fluo-roscopy time and blood loss. Malfixation, which was the most common cause of complications and reoperations, should be avoided.
本研究旨在比较三种不同设计的股骨近端髓内钉（CMN）在治疗不稳定型转子间骨折（UIF）方面的并发症、再次手术、植入物失败、死亡率和功能结果。
本回顾性研究纳入了 2014 年 10 月至 2018 年 10 月期间使用其中一种 CMN（Talon-PFN 组 74 例、PFN-III 组 70 例和 Intertan 组 69 例）治疗 UIF（AO/OTA 31-A2 和 31-A3 型）的患者。
共有 213 名患者（122 名女性和 91 名男性）参与了本研究，平均年龄为 81.0±9.3 岁，平均随访时间为 26.1±6.3 个月。每种 CMN 最常见的并发症都是固定不当，最常见的再次手术原因也是固定不当。各组的并发症和再次手术率、术后功能状态、平均愈合时间和总死亡率相似。Talon-PFN 组的手术/透视时间和平均失血量较低，而 PFN-III 组的这些参数平均值最高。Talon-PFN 组有 6 例（8.2%）植入物失败，PFN-III 组有 1 例（1.5%）。Intertan 组无植入物失败。PFN-III 组获得解剖复位的比例最高（58.6%）。
我们的研究结果表明，每种植入物类型在治疗 UIF 方面都有其自身的优缺点，在功能和再次手术结果方面相似。Intertan 的优势在于没有植入物失败。Talon-PFN 降低了手术/透视时间和术中失血量，但植入物失败率最高。在 PFN-III 组中，需要更多的解剖复位来将两个单独的平行拉力螺钉中心化在股骨颈中，这会增加手术/透视时间和失血量。固定不当是并发症和再次手术的最常见原因，应予以避免。
