使用股骨近端髓内钉治疗股骨转子间骨折：使用 1 枚还是 2 枚头钉？

Treatment of intertrochanteric fractures using cephalomedullary nail: One or two cephalic screws?

机构信息

Hip and orthopedic trauma surgeon, Clínica Universitaria Colombia, Carrera 21 No. 127D-39, Bogotá, 110121 Colombia.

Chief of Orthopedic Trauma Service, Clínica Universitaria Colombia, Bogotá, Colombia.

出版信息

Injury. 2023 Nov;54 Suppl 6:110625. doi: 10.1016/j.injury.2023.02.008.

DOI:10.1016/j.injury.2023.02.008

PMID:38143146

Abstract

OBJECTIVES

To determine the incidence of cut-out, cut-in, cut-through, Z-effect, and reverse Z-effect in two cephalomedullary nail (CMN) systems: one with single cephalic screw fixation and the other with dual-screw fixation using a lag screw and an anti-rotation screw.

METHODS

A retrospective study from a cohort of patients was conducted between January 2017 and August 2019 in patients with intertrochanteric fractures treated with osteosynthesis using CMN.

RESULTS

One hundred ninety-six patients with intertrochanteric fractures who met the inclusion criteria were recruited. The median age was 81 years [interquartile range (IQR) 12]. Seventy-six percent had fractures classified as Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen (OTA/AO) 31A2. Twenty-one mechanical complications occurred, 8.7% (17) was cut-out with a single cephalic screw CMN and 2% (4) was Z-effect with a dual-screw CMN non-integrated. The median tip-apex distance (TAD) was 19.4 mm (IQR 10.8) in patients who experienced cut-out and 19 mm (IQR 10) in those who experienced Z-effect. The median time to cut-out occurrence was 39,5 days (IQR 47,5), while the median time to Z-effect was 90 days (IQR 86).

CONCLUSIONS

The incidence of osteosynthesis failure using CMN is more frequent in patients treated with a single cephalic screw CMN.

LEVEL OF EVIDENCE

Therapeutic, Level III.

摘要

目的

确定两种股骨近端髓内钉（CMN）系统中切出、切入、贯穿、Z 效应和反向 Z 效应的发生率：一种采用单枚头钉固定，另一种采用尾钉和防旋钉的双钉固定。

方法

回顾性研究了 2017 年 1 月至 2019 年 8 月期间采用 CMN 内固定治疗股骨转子间骨折的患者队列。

结果

共纳入 196 例符合纳入标准的股骨转子间骨折患者，中位年龄为 81 岁[四分位间距（IQR）12]。76%的患者骨折类型为美国矫形外科医师协会/骨折内固定研究协会（OTA/AO）31A2 型。发生 21 例机械并发症，8.7%（17 例）为单枚头钉 CMN 切出，2%（4 例）为双钉 CMN 非整合的 Z 效应。发生切出的患者尖端-顶点距离（TAD）中位数为 19.4mm（IQR 10.8），发生 Z 效应的患者 TAD 中位数为 19mm（IQR 10）。切出发生的中位时间为 39.5 天（IQR 47.5），Z 效应的中位时间为 90 天（IQR 86）。