Kinami Yo, Hasei Joe, Fujiwara Kazuo
Department of Orthopaedic Surgery, Okayama City Hospital, Okayama, JPN.
Department of Medical Information and Assistive Technology Development, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN.
Cureus. 2022 Dec 29;14(12):e33110. doi: 10.7759/cureus.33110. eCollection 2022 Dec.
Introduction A useful way to easily evaluate femoral rotation during surgery for trochanteric fractures is not known. Hence, this pilot study aimed to develop an intraoperative indicator to evaluate anteversion in femoral trochanteric fractures. Material and methods Prospectively, from June 2021 to January 2022, all patients with femoral trochanteric fractures (Orthopaedic Trauma Association classification: 31A1-3) treated using a cephalo-medullary nail with a lag-screw neck-shaft angle of 125° were included in this study. During surgery, lag-screw anteversion (LS-AV) was measured using the goniometer application in an iPhone with the fractured femur table-top-plane level with the traction table floor. Accuracy was analyzed by comparing axial-projected lag-screw anteversion (AxP-LS-AV) and three-dimensional computed tomography lag-screw anteversion (3DCT-LS-AV) measurements after surgery. Results Fifty patients (14 males and 36 females) were included in the study. The mean age was 87 (range; 69-98) years; the Orthopaedic Trauma Association classifications were A1 (28 patients), A2 (18 patients), and A3 (4 patients). The mean LS-AV was 10.7° ± 6.9°, the mean AxP-LS-AV was 12.8° ± 8.3°, and the mean 3DCT-LS-AV was 13.1° ± 8.6°. The median difference between AxP-LS-AV and 3DCT-LS-AV was 3.0° (range: 0°-12°), and 40 (80%) patients had differences of ≤5° (Bland-Altman plot: inside of limit of agreement = 86%, paired -test = 0.7, Pearson correlation coefficient = 0.817, <0.001). Conclusion Femur malrotation is defined as a deformity of >15° relative to the normal contralateral limb. Intraoperative LS-AV iPhone measurement on table-top-plane standard had sufficient accuracy as an indicator of anteversion in femoral trochanteric fractures.
引言 目前尚不清楚一种在股骨转子间骨折手术中轻松评估股骨旋转的有效方法。因此，本前瞻性研究旨在开发一种术中指标来评估股骨转子间骨折的前倾角。材料与方法 前瞻性地，从2021年6月至2022年1月，所有使用颈干角为125°的拉力螺钉的股骨转子间骨折患者（骨科创伤协会分类：31A1 - 3）纳入本研究。手术过程中，在股骨骨折与牵引台地面处于桌面平面水平时，使用iPhone上的测角仪应用测量拉力螺钉前倾角（LS - AV）。术后通过比较轴向投影拉力螺钉前倾角（AxP - LS - AV）和三维计算机断层扫描拉力螺钉前倾角（3DCT - LS - AV）测量值分析准确性。结果 本研究纳入50例患者（14例男性和36例女性）。平均年龄为87岁（范围：69 - 98岁）；骨科创伤协会分类为A1（28例患者）、A2（18例患者）和A3（4例患者）。平均LS - AV为10.7°±6.9°，平均AxP - LS - AV为12.8°±8.3°，平均3DCT - LS - AV为13.1°±8.6°。AxP - LS - AV与3DCT - LS - AV之间的中位数差异为3.0°（范围：0° - 12°），40例（80%）患者的差异≤5°（Bland - Altman图：一致性界限内 = 86%，配对t检验 = 0.7，Pearson相关系数 = 0.817，P<0.001）。结论 股骨旋转不良定义为相对于对侧正常肢体>15°的畸形。在桌面平面标准下术中使用iPhone测量LS - AV作为股骨转子间骨折前倾角指标具有足够的准确性。
