Turgut Mehmet Cenk, Bircan Resul, Engin Muhammed Çağatay, Zeynel Alperen, Ulucaköy Coşkun
Dr. Abdurrahman Yurtaslan Ankara Onkoloji Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, 06200 Yenimahalle, Ankara, Türkiye.
Jt Dis Relat Surg. 2025 Jan 2;36(1):137-141. doi: 10.52312/jdrs.2025.1861. Epub 2024 Dec 14.
This study aimed to investigate the importance of the Dorr index in the preoperative evaluation of implant failure in patients who underwent proximal femoral nail (PFN).
This retrospective study examined 312 patients who underwent PFN for intertrochanteric fractures between January 2016 and January 2020. Patients with unstable fractures according to the AO/OTA (AO Foundation/Orthopaedic Trauma Association) classification, those over 65 years of age, with at least one year of regular follow-up, a tip-apex distance <25 mm, and a caput-collum-diaphyseal angle between 125° and 135°, were included. Seventy patients (19 males, 51 females; mean age: 72±3.8 years; range, 65 to 88 years) who met the inclusion criteria were included in the study. According to the Dorr index, patients were type A if the ratio was <0.5, type B if the ratio was between 0.50 and 0.75, and type C if the ratio was >0.75.
The mean follow-up period was 46.2±4.4 months. As indicated by the Dorr index, the failure rates were 0%, 17%, and 63% for Dorr types A, B, and C, respectively. The comparison of failure rates between Dorr types A and B (p=0.02), B and C (p=0.016), and A and C (p=0.001) yielded statistically significant results. Patients with Dorr types B and C exhibited significantly inferior outcomes compared to those with type A. The mean time to failure was 27±3 days after surgery.
Dorr index is an important parameter that can be easily checked and used on preoperative radiographs to predict implant failure. The high probability of failure in the early period should be taken into account, particularly if PFN is planned in Dorr type C.
本研究旨在探讨多氏指数在接受股骨近端髓内钉（PFN）治疗患者的植入物失败术前评估中的重要性。
本回顾性研究检查了2016年1月至2020年1月间因股骨转子间骨折接受PFN治疗的312例患者。纳入标准为根据AO/OTA（AO基金会/骨科创伤协会）分类为不稳定骨折、年龄超过65岁、至少有一年定期随访、尖顶距<25mm且头颈骨干角在125°至135°之间的患者。符合纳入标准的70例患者（19例男性，51例女性；平均年龄：72±3.8岁；范围65至88岁）纳入本研究。根据多氏指数，该比值<0.5为A型患者，比值在0.50至0.75之间为B型患者，比值>0.75为C型患者。
平均随访期为46.2±4.4个月。多氏指数显示，A型、B型和C型患者的失败率分别为0%、17%和63%。A型与B型（p=0.02）、B型与C型（p=0.016）以及A型与C型（p=0.001）之间失败率的比较产生了具有统计学意义的结果。与A型患者相比，B型和C型患者的结局明显较差。失败的平均时间为术后27±3天。
多氏指数是一个重要参数，可在术前X线片上轻松检查并用于预测植入物失败。应考虑早期失败的高概率，特别是在计划对C型患者进行PFN治疗时。
