Department of Orthopedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou, China.
School of Medicine, Xiamen University, Xiamen, China.
Orthop Surg. 2023 Nov;15(11):2805-2813. doi: 10.1111/os.13875. Epub 2023 Sep 28.
The intramedullary nail is considered the gold standard for treating AO/OTA type A3.3 intertrochanteric fractures. However, it still faces a significant rate of failure, mainly due to the critical factor of comminuted lateral wall defects leading to inadequate proximal sliding compression. The primary objective of this study is to investigate the requirement of sliding compression in the treatment of unstable AO/OTA type A3.3 intertrochanteric fractures. To achieve this, we conduct a comparative analysis between two approaches: InterTAN alone and proximal femoral anti-rotation blade nailing (PFNA) combined with lateral wall reconstruction for treating AO/OTA type A3.3 intertrochanteric fractures with lateral wall damage.
A retrospective analysis was conducted on the clinical data of patients who underwent intramedullary nailing fixation for AO/OTA type A3.3 intertrochanteric fractures at our hospital from January 2012 to January 2022. Patient characteristics as well as treatment details, including operative time, intraoperative blood loss, weight-bearing time, fracture healing time, tip apex distance (TAD) loss, Harris hip scores (HHS), Parker-Palmer mobility score (PPMS), and postoperative complications, were collected and analyzed. Continuous variables were analyzed using independent sample t-tests, while categorical variables were examined using the chi-square test. For group comparisons, variance analysis was applied, and pairwise comparisons were conducted using the LSD-t test.
These patients were divided into PFNA combined with lateral wall reconstruction group (sliding compression group) and InterTAN fixation group (static fixation group) based on surgical methods. The operation time, intraoperative bleeding loss, HHS at 12 months and PPMS at 12 months in the sliding compression group were significantly higher than those in the static fixation group, and time to weight-bearing and fracture healing time were significantly lower than those in the static fixation group (p < 0.05). There were no significant differences between two groups in terms of the TAD at 2 days, 2, and 12 months postoperatively, the incidence of complications (p > 0.05). At 6 months postoperatively, femoral neck length was shortened compared to 2 days postoperatively in both groups, and the sliding compression group had a significantly greater degree of femoral neck shortening than the static fixation group (p < 0.05).
The use of PFNA with lateral wall reconstruction for A3.3 intertrochanteric fractures demonstrated superior mobility, efficiency, and reduced internal fixation failure rates compared to InterTAN. These findings suggest that sliding compression may be required for intramedullary nailing treatment.
髓内钉被认为是治疗 AO/OTA 型 A3.3 转子间骨折的金标准。然而，它仍然面临着较高的失败率，主要是由于粉碎性外侧壁缺陷这一关键因素导致近端滑动加压不足。本研究的主要目的是探讨滑动加压在不稳定型 AO/OTA 型 A3.3 转子间骨折治疗中的必要性。为此，我们对两种方法进行了比较分析：单纯 InterTAN 和股骨近端抗旋刀片（PFNA）联合外侧壁重建治疗伴有外侧壁损伤的 AO/OTA 型 A3.3 转子间骨折。
回顾性分析了 2012 年 1 月至 2022 年 1 月我院采用髓内钉固定治疗的 AO/OTA 型 A3.3 转子间骨折患者的临床资料。收集并分析了患者特征以及治疗细节，包括手术时间、术中出血量、负重时间、骨折愈合时间、尖端顶点距离（TAD）丢失、Harris 髋关节评分（HHS）、Parker-Palmer 活动评分（PPMS）以及术后并发症。连续性变量采用独立样本 t 检验进行分析，分类变量采用卡方检验进行分析。组间比较采用方差分析，两两比较采用 LSD-t 检验。
这些患者根据手术方法分为 PFNA 联合外侧壁重建组（滑动加压组）和 InterTAN 固定组（静态固定组）。滑动加压组的手术时间、术中出血量、术后 12 个月 HHS 和术后 12 个月 PPMS 明显高于静态固定组，负重时间和骨折愈合时间明显短于静态固定组（p<0.05）。两组术后 2 天、2 个月和 12 个月 TAD 差异无统计学意义，并发症发生率差异无统计学意义（p>0.05）。术后 6 个月，两组股骨颈长度均较术后 2 天缩短，滑动加压组股骨颈缩短程度明显大于静态固定组（p<0.05）。
与 InterTAN 相比，PFNA 联合外侧壁重建治疗 A3.3 转子间骨折具有更好的活动度、效率和降低内固定失败率。这些发现表明，髓内钉治疗可能需要滑动加压。
