Orthopedics and Trauma Surgery Department, CHU de la Milétrie, Poitiers, France.
Orthopedic Surgery Department, CH de Niort, Niort, France.
Orthop Traumatol Surg Res. 2024 Dec;110(8):103967. doi: 10.1016/j.otsr.2024.103967. Epub 2024 Aug 3.
The concept of restoring the femoral offset is well established during hip replacement surgery, but is less well known when treating Garden I or II femoral neck fractures by internal fixation. And yet, the therapeutic aim for these fractures is to restore this native parameter as best possible. The aim of this study was to identify the risk factors for reduction of femoral offset after union of a Garden I or II femoral neck fracture treated by internal fixation.
After internal fixation of a femoral neck fracture, certain factors may contribute to reducing the femoral offset, which itself has been identified as being responsible for altering the patients' quality of life and functional outcomes.
This multicenter study included 193 patients who had a Garden I or II femoral neck fracture treated by cannulated screws or a sliding compression screw-plate. The difference between the femoral offset in the operated hip and that of the contralateral hip was measured in weightbearing patients after the fracture had healed. This difference was the primary outcome measure. Univariate and multivariate analyses were done to look for risk factors contributing to femoral neck shortening.
Based on the univariate analysis, being more than 85 years of age, having a Garden I fracture, and cannulated screw fixation were associated with a significantly greater reduction in the femoral offset. In the multivariate analysis, only Garden I fractures were associated with a greater reduction in femoral offset.
Garden I fractures were associated with a greater reduction in the offset, although there was no evidence that this change was related to early weightbearing. By identifying this risk factor, surgeons can optimize the indications given that the treatment of these fractures is still widely debated and there is still no consensus as to the best method.
IV.
在髋关节置换术中，恢复股骨偏心距的概念已经得到很好的确立，但在通过内固定治疗 Garden I 或 II 型股骨颈骨折时，这一概念的应用就不那么为人所知了。然而，这些骨折的治疗目标是尽可能恢复这一固有参数。本研究旨在确定通过内固定治疗 Garden I 或 II 型股骨颈骨折后，股骨偏心距减小的危险因素。
在股骨颈骨折内固定后，某些因素可能会导致股骨偏心距减小，而股骨偏心距减小本身已被确定为影响患者生活质量和功能结果的因素。
这项多中心研究纳入了 193 例接受空心螺钉或滑动加压钢板内固定治疗的 Garden I 或 II 型股骨颈骨折患者。在骨折愈合后，在负重患者中测量患侧髋关节和对侧髋关节的股骨偏心距差值，该差值为主要观察指标。进行单因素和多因素分析，寻找导致股骨颈缩短的危险因素。
基于单因素分析，年龄大于 85 岁、Garden I 型骨折和空心螺钉固定与股骨偏心距显著减小相关。多因素分析显示，只有 Garden I 型骨折与股骨偏心距减小相关。
Garden I 型骨折与偏心距减小相关，尽管没有证据表明这种变化与早期负重有关。通过识别这一危险因素，外科医生可以优化适应证，因为这些骨折的治疗仍然存在广泛争议，对于最佳治疗方法尚无共识。
IV 级。
