Orthopaedics and Sports Medicine, USF Health, South Florida, Florida, USA.
Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA.
Iowa Orthop J. 2024;44(1):167-171.
This study aimed to demonstrate the feasibility of lag screw exchange for painful lateral soft tissue impingement in patients initially treated with cephalomedullary nailing (CMN) for an intertrochanteric hip fracture.
Ten patients initially treated with CMN for unstable intertrochanteric fractures presenting with persistent pain and radiographic evidence of lag screw lateral migration were treated with exchange of original screw with shorter lag screw buried in the lateral cortex to prevent impingement. Patients were evaluated for resolution of pain and achievement of pre-fracture ambulatory status at 6 months post-operatively.
Average age was 71.5 years (range: 62-88). Average length of follow-up was 24.9 months. All patients were female, with an average Charlson Comorbidity Index of 1.0 (0-3) and average Body Mass Index of 22.2 (16.0-31.1). Five of ten patients (50.0%) were treated with a cortisone injection in the trochanteric bursa prior to screw exchange with temporary pain relief. Five (50.0%) patients presented with limited range of hip motion. Five (50.0%) had history of prior or current bisphosphonate use. Average lag screw prominence was noted to be 12.2mm (7.9-17.6mm) on radiographic evaluation. Screw exchange was performed at an average of 18.6 months (5.4-44.9 months) following the index procedure. Average operating time of the screw exchange procedure was 45.3 minutes (34-69 minutes) and blood loss was <50mL in all cases. Replacement lag screws were an average of 16.0mm (10-25mm) shorter than the initial screw. All patients achieved complete or significant resolution of lateral thigh pain, and nine (90%) returned to pre-fracture ambulatory status by eight weeks after screw exchange. All patients remained pain free at six months after screw exchange.
Lag screw exchange is a efficacious method to address the mechanical irritation of laterally protruding lag screws following IT hip fracture, while also prophylaxing against subsequent femoral neck fractures. .
本研究旨在证明对于因股骨转子间骨折初始接受股骨近端髓内钉（cephalomedullary nailing，CMN）治疗后出现疼痛性外侧软组织撞击的患者，更换拉力螺钉的可行性。
10 例初始接受 CMN 治疗不稳定股骨转子间骨折的患者，出现持续性疼痛和拉力螺钉外侧迁移的影像学证据，采用更换原始螺钉的方法治疗，使用较短的拉力螺钉埋置于外侧皮质以防止撞击。术后 6 个月评估患者疼痛缓解情况和恢复术前步行状态。
平均年龄为 71.5 岁（范围：62-88 岁）。平均随访时间为 24.9 个月。所有患者均为女性，平均 Charlson 合并症指数为 1.0（0-3），平均体重指数为 22.2（16.0-31.1）。10 例患者中有 5 例（50.0%）在更换螺钉前接受了转子间囊皮质内注射皮质激素，暂时缓解了疼痛。5 例（50.0%）患者髋关节活动范围有限。5 例（50.0%）患者有既往或当前使用双膦酸盐的病史。影像学评估发现平均拉力螺钉突出 12.2mm（7.9-17.6mm）。螺钉更换手术平均在初次手术后 18.6 个月（5.4-44.9 个月）进行。螺钉更换手术的平均手术时间为 45.3 分钟（34-69 分钟），所有病例出血量均<50mL。更换的拉力螺钉比初始螺钉平均短 16.0mm（10-25mm）。所有患者的大腿外侧疼痛完全或显著缓解，9 例（90%）在螺钉更换后 8 周内恢复到骨折前的步行状态。所有患者在螺钉更换后 6 个月内均无疼痛。
更换拉力螺钉是治疗股骨转子间骨折后外侧突出拉力螺钉机械刺激的有效方法，同时也可预防后续股骨颈骨折。
