Çeliksöz Aytek Hüseyin, Köse Nusret, Turgut Akın, Gökturk Erol
Department of Orthopaedics and Traumatology, Eskisehir City Hospital, Eskişehir, Turkey.
Department of Orthopaedics and Traumatology, Eskişehir Osmangazi University, Eskişehir, Turkey.
Geriatr Orthop Surg Rehabil. 2025 Mar 31;16:21514593251328929. doi: 10.1177/21514593251328929. eCollection 2025.
Hip fractures are common in older adults and are associated with significant morbidity and mortality. Surgical fixation with intramedullary devices, such as proximal femoral nails (PFN), is a common treatment method. However, complications such as implant cut-out remain a challenge despite advancements in implant designs. The objective of this study was to evaluate the clinical experience with different PFN designs and lag screws and to compare implant cut-out rates. Additionally, the study aimed to identify the most important factors that could prevent complications and predict cut-out. This retrospective study included 145 patients with trochanteric fractures who had undergone surgical treatment with PFN devices between January 2015 and December 2018. Patients younger than 65 years, those with pathological fractures, ipsilateral pelvic and knee fractures, subtrochanteric fractures, and multiple traumas were excluded. Radiographs were evaluated to determine osteoporosis, fracture type, implant type, fracture reduction quality, early and late neck shaft angle (NSA), lag screw position in the femoral head, tip-apex distance (TAD), and cut-out. Fractures were classified according to the AO/OTA classification system, and the quality of fracture reduction was assessed using the Baumgaertner classification. The Cleveland method was used to record the location of the screw/blade within the head. The study compared the implant features of four different PFN devices, including Double lag screw PFN, Wedge wing lag screw PFN nail, Helical blade PFN, and Integrated Dual Screw PFN. The statistical analysis indicated that early and late NSA, TAD, Reduction quality of fracture, Cleveland index, and the difference between PFN types were risk factors for Cut-out. ( ≤ .001). Patients with helical blade PFN had a significantly higher rate of cut-out compared to other PFN devices. Univariate and multivariate regression analyses identified the Cleveland Index, fracture reduction quality ( ≤ .001), TAD, and early and late NSA as significant predictors for cut-out complications ( ≤ .001). Patients with poor Cleveland Index, poor fracture reduction quality, low TAD, and low NSA had a higher risk of cut-out ( ≤ .001). In conclusion, careful consideration of patient and surgical factors, including implant design and placement, is crucial in minimizing the risk of complications such as cut-out.
髋部骨折在老年人中很常见，且与显著的发病率和死亡率相关。使用髓内装置进行手术固定，如股骨近端髓内钉（PFN），是一种常见的治疗方法。然而，尽管植入物设计有所进步，但诸如植入物穿出等并发症仍然是一个挑战。本研究的目的是评估不同PFN设计和拉力螺钉的临床经验，并比较植入物穿出率。此外，该研究旨在确定可预防并发症并预测穿出的最重要因素。这项回顾性研究纳入了145例在2015年1月至2018年12月期间接受PFN装置手术治疗的转子间骨折患者。排除年龄小于65岁的患者、病理性骨折患者、同侧骨盆和膝关节骨折患者、转子下骨折患者以及多发伤患者。通过评估X线片来确定骨质疏松情况（此处原文“骨质疏松”后少了相关内容）、骨折类型、植入物类型、骨折复位质量、早期和晚期颈干角（NSA）、拉力螺钉在股骨头中的位置、尖顶距（TAD）以及穿出情况。骨折根据AO/OTA分类系统进行分类，骨折复位质量使用鲍姆加特纳分类法进行评估。采用克利夫兰方法记录螺钉/刀片在股骨头内的位置。该研究比较了四种不同PFN装置的植入物特征，包括双拉力螺钉PFN、楔形翼拉力螺钉PFN钉、螺旋刀片PFN和一体化双螺钉PFN。统计分析表明，早期和晚期NSA、TAD、骨折复位质量、克利夫兰指数以及PFN类型之间的差异是穿出的危险因素（P≤.001）。与其他PFN装置相比，使用螺旋刀片PFN的患者穿出率显著更高。单因素和多因素回归分析确定克利夫兰指数、骨折复位质量（P≤.001）、TAD以及早期和晚期NSA是穿出并发症的显著预测因素（P≤.001）。克利夫兰指数差、骨折复位质量差、TAD低和NSA低的患者穿出风险更高（P≤.001）。总之，仔细考虑患者和手术因素，包括植入物设计和放置，对于将诸如穿出等并发症的风险降至最低至关重要。 （原文中部分表述如骨质疏松处可能存在信息缺失，已按完整逻辑尽量翻译）
