Department of Orthopaedics and Traumatology, Konya City Hospital, Akabe District, Adana Road, Konya, 42020, Turkey.
Department of Orthopaedics and Traumatology, Kahramanmaras Necip Fazıl City Hospital, Gaziantep Road 12nd Km. Karacasu Kırım District, Kahramanmaras, 46080, Turkey.
BMC Musculoskelet Disord. 2024 Oct 5;25(1):790. doi: 10.1186/s12891-024-07859-3.
Fixation of trochanteric fractures with an intramedullary nail in a non-physiological position can cause poor functional outcomes. The aim of this study is to evaluate the effect of intraoperative patient position on rotational alignment in intramedullary nail fixation of trochanteric fractures.
The femoral rotational alignment of 84 trochanteric fracture patients who underwent intramedullary nailing was measured by computed tomography (CT) images. Patients were divided into two groups: the supine position on the fracture table (FT) (Group 1, n = 42) and the lateral decubitus (LD) position (Group 2, n = 42). Femoral malrotation angles were measured and divided into three subgroups: insignificant, significant, and excessive. The number of intraoperative fluoroscopy images, preparation time, surgery time, and anesthesia time in both groups were compared.
The malrotation degrees of patients in Group 1 ranged from 17° external rotation (ER) to 57° internal rotation (IR), with a mean of 10° IR. Of the patients in Group 1, 27 were insignificant, 5 were significant, and 10 were in the excessive subgroup. The malrotation degrees of patients in Group 2 ranged from 33° ER to 47° IR, with a mean of 11° IR. Of the patients in Group 2, 21 were insignificant, 12 were significant, and 9 were in the excessive subgroup. There was no statistically significant relationship between patient position and malrotation angle. The number of intraoperative fluoroscopy images, preparation time, and anesthesia time were statistically lower in Group 2. There was no statistically significant difference between Group 1 and Group 2 in terms of surgery time.
Intramedullary nailing in the LD position is a reliable and practical surgical method in the treatment of femoral trochanteric fractures since there is no need for the use of a FT, the surgeon is exposed to less radiation, there is no risk of complications related to the traction of the FT, and there is a shorter operation time.
在非生理位置使用髓内钉固定转子间骨折会导致功能预后不佳。本研究旨在评估术中患者体位对髓内钉固定转子间骨折旋转对线的影响。
通过计算机断层扫描（CT）图像测量 84 例股骨转子间骨折患者的股骨旋转对线。患者分为两组：骨折台上仰卧位（FT）组（n=42）和侧卧位（LD）组（n=42）。测量股骨旋转角度，并分为三个亚组：无意义、显著和过度。比较两组患者的术中透视次数、准备时间、手术时间和麻醉时间。
FT 组患者的旋转角度范围为 17°外旋（ER）至 57°内旋（IR），平均为 10° IR。FT 组患者中，27 例为无意义，5 例为显著，10 例为过度。LD 组患者的旋转角度范围为 33° ER 至 47° IR，平均为 11° IR。LD 组患者中，21 例为无意义，12 例为显著，9 例为过度。患者体位与旋转角度之间无统计学相关性。LD 组术中透视次数、准备时间和麻醉时间均明显低于 FT 组。两组手术时间无统计学差异。
在治疗股骨转子间骨折时，LD 位髓内钉固定是一种可靠且实用的手术方法，因为它不需要使用 FT，术者暴露于射线较少，没有与 FT 牵引相关的并发症风险，而且手术时间较短。
