Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.
Key Laboratory of Biomechanics of Hebei Province, Hebei Orthopedic Research Institute, Shijiazhuang, Hebei, 050051, People's Republic of China.
Int Orthop. 2024 Jul;48(7):1839-1848. doi: 10.1007/s00264-024-06168-7. Epub 2024 Apr 6.
The optimal choice of distal locking modes remains a subject due to limited available data, and therefore, this study aims to investigate the relationship between distal locking mode and postoperative mechanical complications in an intertrochanteric fracture (ITF) population who underwent closed reduction and intramedullary fixation with a PFNA-II.
Patients aged 65 years or older who underwent surgery with PFNA-II fixation in a university teaching hospital between January 2020 and December 2021 were potentially eligible. Based on the distal locking mode, patients were classified into static, dynamic, and limited dynamic groups, among which the differences were tested using univariate analysis. Multivariate logistic regression was used to examine whether the distal locking mode was independently associated with the risk of postoperative one year mechanical complications, adjusting for covariates and potential confounders. Subgroup analyses were performed to evaluate the robustness of the findings.
Among 507 eligible patients, 33 (6.5%) developed postoperative mechanical complications. In the univariate analysis, sex (P = 0.007), fracture type (P = 0.020), LAT Parker ratio (P = 0.023), and lateral femoral (P = 0.003) wall showed that the differences were significant. Compared to the static group, the limited dynamic group and the dynamic group showed higher odds of postoperative mechanical complications (OR = 3.314, 95% CI: 1.215-9.041; and OR = 3.652, 95% CI: 1.451-9.191, respectively). These associations were robust across a series of analyses, including adjusting for confounders and subgroup analyses.
Using a distal non-static locking mode significantly increases the risk of postoperative mechanical complications, and static locking could be a preferable option when treating an intertrochanteric fracture.
由于可用数据有限，远端锁定模式的最佳选择仍然是一个问题，因此，本研究旨在调查股骨近端防旋髓内钉-II（PFNA-II）闭合复位内固定治疗股骨转子间骨折（ITF）人群中远端锁定模式与术后机械并发症之间的关系。
在 2020 年 1 月至 2021 年 12 月期间，在一家大学教学医院接受 PFNA-II 固定手术的年龄在 65 岁或以上的患者有资格入组。根据远端锁定模式，患者分为静态、动态和有限动态组，使用单变量分析比较组间差异。多变量逻辑回归用于检验远端锁定模式是否与术后 1 年机械并发症的风险独立相关，调整协变量和潜在混杂因素。进行亚组分析以评估结果的稳健性。
在 507 例符合条件的患者中，有 33 例（6.5%）发生术后机械并发症。单变量分析显示，性别（P=0.007）、骨折类型（P=0.020）、LAT Parker 比值（P=0.023）和外侧股骨（P=0.003）壁有显著差异。与静态组相比，有限动态组和动态组术后机械并发症的发生风险更高（OR=3.314，95%CI：1.215-9.041；OR=3.652，95%CI：1.451-9.191）。这些关联在一系列分析中是稳健的，包括调整混杂因素和亚组分析。
使用非静态远端锁定模式显著增加了术后机械并发症的风险，在治疗股骨转子间骨折时，静态锁定可能是一种更可取的选择。
