Zhu Naifeng, Wu Lianxia, Han Xiaofeng, Qian Zhonglai
Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Orthopaedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Front Bioeng Biotechnol. 2024 Nov 1;12:1426307. doi: 10.3389/fbioe.2024.1426307. eCollection 2024.
The tip-apex distance is a key factor in predicting implant cut-out after intramedullary fixation for intertrochanteric fractures. This study aimed to evaluate the factors associated with an increased tip-apex distance when treating intertrochanteric fractures using an InterTAN nail.
We retrospectively analyzed patients with intertrochanteric fractures who underwent InterTAN nail insertion between January 2017 and March 2022 at our hospital. Medical and radiological data were collected. Measurements of preoperative factors and postoperative factors were performed accordingly. Multivariate logistic regression analysis was performed to determine the statistically significant variables of the tip-apex distance.
This study included 102 patients with intertrochanteric fractures. The average tip-apex distance measured 22.4 ± 7.1 mm, ranging from 9.3 to 48.0 mm. The length of the femoral neck on the non-fractured side, lag screw placement in the sagittal plane (center-inferior, superior) and coronal plane (posterior), and the angle between the line of the proximal nail axis and the femoral long axis were identified to be statistically significant factors for the tip-apex distance.
To obtain a shorter tip-apex distance, we recommend a medial trochanteric entry point to minimize the angle between the line of the proximal nail axis and the femoral long axis. Additionally, sufficiently deep central insertion of the lag screw was advised in both the sagittal and coronal planes.
尖顶距离是预测股骨转子间骨折髓内固定后植入物穿出的关键因素。本研究旨在评估使用InterTAN钉治疗股骨转子间骨折时与尖顶距离增加相关的因素。
我们回顾性分析了2017年1月至2022年3月在我院接受InterTAN钉植入的股骨转子间骨折患者。收集了医学和放射学数据。相应地进行术前因素和术后因素的测量。进行多因素逻辑回归分析以确定尖顶距离的统计学显著变量。
本研究纳入了102例股骨转子间骨折患者。平均尖顶距离为22.4±7.1毫米，范围为9.3至48.0毫米。未骨折侧股骨颈的长度、拉力螺钉在矢状面（中心-下方、上方）和冠状面（后方）的位置，以及近端钉轴与股骨干长轴之间的角度被确定为尖顶距离的统计学显著因素。
为了获得更短的尖顶距离，我们建议采用转子内侧入点，以尽量减小近端钉轴与股骨干长轴之间的角度。此外，建议在矢状面和冠状面将拉力螺钉充分深入中心插入。
