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钢板、短钉还是长钉？三种不同治疗方法治疗股骨转子周围骨折的翻修率及并发症

Plate, short nail, or long nail? Revision rates and complications of three different treatments for peritrochanteric femur fractures.

作者信息

Poffenbarger Mason, Werthmann Neil, Parikh Kisan, Riehl John

机构信息

HCA Medical City Healthcare UNT-TCU GME (Denton) Program, Texas Bone and Joint, United States.

出版信息

J Orthop. 2024 Oct 23;63:43-47. doi: 10.1016/j.jor.2024.10.022. eCollection 2025 May.

DOI:10.1016/j.jor.2024.10.022
PMID:39553838
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11564781/
Abstract

BACKGROUND

We sought to investigate the relationship between peritrochanteric femur fracture (OTA 31A fractures) fixation and rates of peri-implant fracture, rates of transfusion, and the rates of increased dependence after secondary surgery for fracture for short cephalomedullary nails (SCMN), long cephalomedullary nails (LCMN), and plate and screw devices (PSD).

METHODS

Multi center retrospective study involving data collected from 151 Level I-IV trauma centers using ICD9/10 and CPT codes for identification. 13,197 patients with peritrochanteric femur fractures between 2016 and 2021 were included in analysis.

RESULTS

We report no significant difference in peri-implant fractures in extramedullary and intramedullary devices (LCMN 50, 0.84 %; SCMN 57, 0.88 %; PSD 6, 0.74 %; p = 0.91) as well as no significant difference in the rates of discharge to home after surgical fixation of a peri-implant fracture.

CONCLUSIONS

There is no difference in peri-implant fracture rates between SCMN, LCMN, and PSD methods of fixation for peritrochanteric femur fractures. Therefore, longer implants do not seem to protect the femur from future peri-implant fracture when compared to shorter implants. Further analysis is needed to more fully elucidate the morbidity associated with readmission and revision of peri-implant fractures following fixation of peritrochanteric femur fractures.

LEVEL OF EVIDENCE

Therapeutic Level III.

摘要

背景

我们试图研究股骨转子周围骨折（OTA 31A骨折）的固定方式与植入物周围骨折发生率、输血率以及短型髓内钉（SCMN）、长型髓内钉（LCMN）和钢板螺钉装置（PSD）二次骨折手术后依赖增加率之间的关系。

方法

多中心回顾性研究，通过使用ICD9/10和CPT编码进行识别，收集来自151个I - IV级创伤中心的数据。分析纳入了2016年至2021年间13197例股骨转子周围骨折患者。

结果

我们报告，髓外和髓内装置的植入物周围骨折发生率无显著差异（LCMN 50例，0.84%；SCMN 57例，0.88%；PSD 6例，0.74%；p = 0.91），植入物周围骨折手术固定后出院回家的比率也无显著差异。

结论

SCMN、LCMN和PSD固定方法治疗股骨转子周围骨折时，植入物周围骨折发生率无差异。因此，与较短的植入物相比，较长的植入物似乎并不能保护股骨免受未来植入物周围骨折的影响。需要进一步分析以更全面地阐明股骨转子周围骨折固定后植入物周围骨折再次入院和翻修相关的发病率。

证据水平

治疗性III级。

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本文引用的文献

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Risk of Peri-implant Fracture With Long Versus Short Cephalomedullary Nailing for Geriatric Patients With Intertrochanteric Femur Fracture.长与短股骨近端髓内钉治疗老年股骨转子间骨折患者的围手术期骨折风险。
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Comparison of Short, Intermediate, and Long Cephalomedullary Nail Length Outcomes in Elderly Intertrochanteric Femur Fractures.比较短、中、长股骨近端髓内钉长度在老年股骨转子间骨折中的结果。
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Perm J. 2020;24. doi: 10.7812/TPP/19.229.
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Short Versus Long Cephalomedullary Nails for Pertrochanteric Hip Fractures: A Randomized Prospective Study.短柄与长柄股骨近端髓内钉治疗股骨转子间骨折：一项随机前瞻性研究。
J Orthop Trauma. 2019 Oct;33(10):480-486. doi: 10.1097/BOT.0000000000001553.
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Comparison of Short-term Complication Rates Between Cephalomedullary Hip Screw Devices and Sliding Hip Screws: An Analysis of the National Surgical Quality Improvement Program Database.Cephalomedullary 髋螺钉装置与滑动髋螺钉短期并发症发生率的比较：国家手术质量改进计划数据库分析。
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