Department of Orthopedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, Republic of Korea.
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea.
Medicina (Kaunas). 2023 May 27;59(6):1035. doi: 10.3390/medicina59061035.
: There were limited studies which investigated nail diameter as a predictor for cephalomedullary nail (CMN) failure in intertrochanteric fracture (ITF). We aimed to evaluate the surgical outcomes of CMN in fragility ITF following nail-canal (N-C) diameter discordance. : From November 2010 to March 2022, we retrospectively reviewed 120 consecutive patients who underwent CMN surgeries due to fragility ITF. We included patients with acceptable reduction and a tip-apex distance ≤ 25 mm. The N-C diameter differences both in anterior-posterior (AP) and lateral-view X-rays were measured, and we compared the number of excessive sliding instances and the rate of implant failure between the N-C concordance (≤3 mm) and discordance (>3 mm) group. Simple linear regression was used to determine the strength of the relationship between the N-C difference and sliding distance. : The sliding distance showed no differences between the groups in the AP (3.6 vs. 3.3 mm, = 0.75) and lateral view (3.5 vs. 3.4 mm, = 0.91). For analyses in the AP view, the AP-concordance and AP-discordance groups had 14 (25%) and 14 patients (22%) with a sliding distance of >5 mm ( = 0.69), while treatment failure occurred in 3 (5%) and 3 (3%) patients, respectively ( = 0.66). For analyses in the lateral view, the lat-concordance and lat-discordance groups had 8 (27%) and 20 patients (22%) with a sliding distance of >5 mm ( = 0.62), while treatment failure occurred in 1 (3%) and 4 (4%) patients, respectively ( = 1.00). Linear regression analyses showed that the N-C difference in either views was not a significant predictor of sliding distance in both the AP (R = 0.002, = 0.60) and lateral views (R = 0.007, = 0.35). : If appropriate fracture reduction and fixation are achieved, the N-C discordance of short CMN does not affect treatment outcomes in ITF.
：有一些研究调查了指骨直径作为预测股骨髓内钉（CMN）在转子间骨折（ITF）中失效的指标。我们旨在评估在脆性 ITF 中，CMN 在钉道（N-C）直径不一致的情况下的手术结果。
：从 2010 年 11 月至 2022 年 3 月，我们回顾性分析了 120 例因脆性 ITF 而行 CMN 手术的连续患者。我们纳入了具有可接受的复位和尖端 - 顶点距离≤25mm 的患者。在前后位（AP）和侧位 X 线片上测量 N-C 直径差异，并比较 N-C 一致（≤3mm）和不一致（>3mm）组之间过多滑动的次数和植入物失败的发生率。简单线性回归用于确定 N-C 差异与滑动距离之间关系的强度。
：在 AP（3.6 与 3.3mm，=0.75）和侧位（3.5 与 3.4mm，=0.91）视图中，两组之间的滑动距离无差异。对于 AP 视图的分析，AP 一致组和 AP 不一致组分别有 14 名（25%）和 14 名（22%）患者的滑动距离>5mm（=0.69），而治疗失败分别发生在 3 名（5%）和 3 名（3%）患者中（=0.66）。对于侧位视图的分析，lat 一致组和 lat 不一致组分别有 8 名（27%）和 20 名（22%）患者的滑动距离>5mm（=0.62），而治疗失败分别发生在 1 名（3%）和 4 名（4%）患者中（=1.00）。线性回归分析表明，在 AP（R=0.002，=0.60）和侧位视图（R=0.007，=0.35）中，N-C 差异均不是滑动距离的显著预测因素。
：如果获得适当的骨折复位和固定，短 CMN 的 N-C 不一致不会影响 ITF 的治疗结果。
