Aygün Ümit, Şenocak Eyüp, Aksay Mehmet Fatih, Çiçek Ali Can, Halaç Orkun, Toy Serdar
Faculty of Medicine, Department of Orthopaedics and Traumatology, Ağrı İbrahim Çeçen University, Ağrı, Türkiye.
Faculty of Medicine, Department of Orthopaedics and Traumatology, Atatürk University, Erzurum, Türkiye.
BMC Musculoskelet Disord. 2024 Dec 20;25(1):1051. doi: 10.1186/s12891-024-08197-0.
This study aimed to assess important criteria, including osteoporosis, fracture type, implant position within the bone, fracture reduction, and radiographic union, in patients with intertrochanteric femoral fractures treated with proximal femoral nail (PFN) fixation and to show their effect on clinical outcomes.
PFN fixation was applied in 73 patients (41 females, 32 males; mean age: 64.5 ± 6.2). The T score, fracture type according to the AO Foundation and Orthopedic Trauma Association (AO/OTA), implant-related complications (IRCs), Harris hip score (HHS), Jensen social function (JSF) score, and Parker-Palmer mobility score (PPMS), postoperative reduction classification, screw position according to the Cleveland zone, Radiographic Union Scale for the Hip (RUSH) score, and tip-apex distance (TAD) were recorded.
Most screws were in central-central (n = 42) and inferior-central (n = 11) positions. IRCs were seen mostly in cases of screws placed in peripheral zones (n = 10) and were not observed in almost any patient with a TAD ≤ 25 mm (n = 52) (p < 0.001). Most of the patients with acceptable or good fracture reduction did not have IRCs (n = 11 and 50, respectively) (p < 0.001). Half of type 3A1 (n = 13) and most type 3A2 (n = 20) fractures showed radiographic union at 3 months, and most type 3A3 (n = 9) fractures showed radiographic union at 5 months (p < 0.05). At 12 months, type 3A2 fractures had the highest HHS (79.2 ± 5.3) and PPMS (3.9 ± 1.5), while type 3A3 fractures had the lowest HHS (70.3 ± 4.6) and PPMS (0.6 ± 2.8) (p < 0.05). At 12 and 24 months, type 3A3 fractures had higher JSF scores (2.8 ± 0.4 and 3.5 ± 0.5, respectively); at 3 months, type 3A1 fractures had higher JSF scores (3.1 ± 0.3) (p < 0.05). The radiographic bone union time was prolonged in patients with a T score ≤ -2.5 standard deviation (SD) (p < 0.05). The HHS and PPMS increased while the RUSH score, considered as the radiographic union, was going towards the 4th month and decreased after the 4th month (p < 0.05).
Considering the criteria (osteoporosis, fracture type, implant position within the bone, fracture reduction, and radiographic union) examined in this study, satisfactory results can be obtained with PFN fixation in the treatment of patients with intertrochanteric femoral fractures.
本研究旨在评估采用股骨近端髓内钉（PFN）固定治疗的股骨转子间骨折患者的重要标准，包括骨质疏松症、骨折类型、植入物在骨内的位置、骨折复位情况及影像学愈合情况，并展示这些因素对临床结果的影响。
对73例患者（41例女性，32例男性；平均年龄：64.5±6.2岁）采用PFN固定。记录T值、根据AO骨科学会和骨科创伤协会（AO/OTA）分类的骨折类型、植入物相关并发症（IRC）、Harris髋关节评分（HHS）、詹森社会功能（JSF）评分、帕克-帕尔默活动度评分（PPMS）、术后复位分级、根据克利夫兰区域划分的螺钉位置、髋关节影像学愈合量表（RUSH）评分及尖顶距（TAD）。
大多数螺钉位于中央-中央（n = 42）和下方-中央（n = 11）位置。IRC大多出现在螺钉置于周边区域的病例中（n = 10），而在几乎所有TAD≤25 mm的患者中未观察到IRC（n = 52）（p < 0.001）。大多数骨折复位可接受或良好的患者没有IRC（分别为n = 11和50）（p < 0.001）。半数3A1型（n = 13）和大多数3A2型（n = 20）骨折在3个月时显示影像学愈合，大多数3A3型（n = 9）骨折在5个月时显示影像学愈合（p < 0.05）。在12个月时，3A2型骨折的HHS最高（79.2±5.3），PPMS最高（3.9±1.5），而3A3型骨折的HHS最低（70.3±4.6），PPMS最低（0.6±2.8）（p < 0.05）。在12个月和24个月时，3A3型骨折的JSF评分较高（分别为2.8±0.4和3.5±0.5）；在3个月时，3A1型骨折的JSF评分较高（3.1±0.3）（p < 0.05）。T值≤ -2.5标准差（SD）的患者影像学骨愈合时间延长（p < 0.05）。HHS和PPMS在向第4个月发展时升高，而被视为影像学愈合的RUSH评分在第4个月后下降（p < 0.05）。
考虑到本研究中所检查的标准（骨质疏松症、骨折类型、植入物在骨内的位置、骨折复位及影像学愈合），PFN固定治疗股骨转子间骨折患者可获得满意结果。
