Yang Yun-Fa, Huang Jian-Wen, Gao Xiao-Sheng, Xu Zhong-He
Department of Orthopaedic Surgery, Guangzhou First People's Hospital, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
Front Surg. 2022 Oct 18;9:956877. doi: 10.3389/fsurg.2022.956877. eCollection 2022.
The aim of this study was to investigate an eccentric distance (ED) zone analysis system for regional evaluation of the cephalic fixator tip based on the ED of the cephalic fixator tip referenced to the radius of its own femoral head to predict cut-out in intertrochanteric fractures (ITF) with internal fixation.
First, we assumed all the femoral heads were regular spheres with the radius ( ) of "3" for a complete match of the Cleveland zone system and calculated the ED of the cephalic fixator tip by measuring the distances from the cephalic fixator tip to the geometric central axis in the femoral neck and head on both anteroposterior (AP) view and lateral view radiographs. Second, we defined the maximum transverse section of the femoral head into three zones named ED Zone A with ED less than "1," Zone B with ED ranging in "1-2," and Zone C with ED ranging in "2-3" in turns by concentric circles (circles A, B, and C) with the radius of 1/3, 2/3, and 3/3 times of , respectively. Third, we evaluated the ED zones according to the ED and location of the cephalic fixator tip in the eligible 123 ITF patients with single-screw cephalomedullary nail (SCMN) fixation and then analyzed the correlation between the cut-out rate and the ED zones.
The cut-out rates in ED Zones A, B, and C were 4.17%, 38.46%, and 100%, respectively. Multivariate logistic regression indicated that ED Zone A had at least a 14 times lower rate of cut-out compared with ED Zone B. The cephalic fixator tip located in ED Zone A has a lower cut-out rate than that in Cleveland Zone 5. The cut-out rate in ED Zone A is significantly lower than that in the region inside Cleveland Zone 5 but outside ED Zone A.
ED zone analysis system is a reliable regional evaluation of the cephalic fixator tip position for predicting cut-out in geriatric ITF patients with SCMN fixations and potentially an artificial intelligence measurement during surgery. For decreasing the cut-out rate, the cephalic fixator tip should be located in ED Zone A.
本研究旨在探讨一种偏心距（ED）区域分析系统，该系统基于头钉相对于自身股骨头半径的偏心距，对头钉尖端进行区域评估，以预测股骨转子间骨折（ITF）内固定时的穿出情况。
首先，为使克利夫兰区域系统完全匹配，我们假设所有股骨头均为半径（ ）为“3”的规则球体，并通过在前后位（AP）视图和侧位X线片上测量头钉尖端到股骨颈和股骨头几何中心轴的距离，计算头钉尖端的偏心距。其次，我们将股骨头的最大横截面积通过同心圆（圆A、B和C）依次划分为三个区域，分别命名为偏心距小于“1”的ED区域A、偏心距在“1 - 2”之间的区域B和偏心距在“2 - 3”之间的区域C，其半径分别为 的1/3、2/3和3/3倍。第三，我们根据123例符合条件的单枚螺钉股骨近端髓内钉（SCMN）固定的ITF患者头钉尖端的偏心距和位置评估偏心距区域，然后分析穿出率与偏心距区域之间的相关性。
ED区域A、B和C的穿出率分别为4.17%、38.46%和100%。多因素逻辑回归表明，与ED区域B相比，ED区域A的穿出率至少低14倍。位于ED区域A的头钉尖端穿出率低于克利夫兰区域5。ED区域A的穿出率显著低于克利夫兰区域5内但在ED区域A之外的区域。
偏心距区域分析系统是一种可靠的对头钉尖端位置进行区域评估的方法，可用于预测老年SCMN固定的ITF患者的穿出情况，并可能用于术中人工智能测量。为降低穿出率，头钉尖端应位于ED区域A。
