Han Chao, Li Xiao-Dan, Han Zhe, Dong Qiang
Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, PR China.
Department of Anesthesiology, Tianjin First Center Hospital, Tianjin, PR China.
Geriatr Orthop Surg Rehabil. 2025 Jul 28;16:21514593251363296. doi: 10.1177/21514593251363296. eCollection 2025.
To quantify rotational displacement following intramedullary nail fixation for intertrochanteric femoral fractures using three-dimensional (3D) CT imaging, analyze associated risk factors, and evaluate its clinical significance.
This study enrolled a cohort of 252 patients who underwent intramedullary nail fixation for intertrochanteric femoral fractures between 2019 and 2023. All participants underwent postoperative three-dimensional computed tomography (3D CT) and were followed for a minimum of 1 year. Postoperative femoral anteversion on the affected side was quantitatively assessed. An analysis was conducted to evaluate its correlation with potential risk factors, including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, nail length, type of internal fixation, reduction quality, AO Foundation/Orthopaedic Trauma Association (AO/OTA) fracture classification, presence of medial cortical defect, bone mineral density (T-score), Singh's index, relative lateral wall thickness (rLWT), tip-apex distance (TAD), neck-shaft angle, and fracture classification. The impact of differences in anteversion on long-term clinical outcomes, including Visual Analog Scale (VAS) pain scores and Harris Hip Scores (HHS), was assessed through follow-up evaluations.
After screening for exclusion criteria, a total of 210 patients were enrolled in the study: 33 patients (15.7%) exhibited differences in anteversion exceeding 15°; 177 patients (84.3%) were under 15°. In the subgroup with version deviations <15°, precise anatomical restoration (anteversion ≤5°) was achieved in 138 cases (77.9%), consistent with optimal biomechanical reconstruction targets; functionally compensated malrotation (5° < anteversion <15°) occurred in 39 patients (22.1%), within the tolerance range for gait adaptation without clinical impairment. Single-nail fixation, medial cortical defects, T-score >2.5, rLWT and fracture classification were identified as the primary factors contributing to rotational displacement exceeding 15°. At the 1-year follow-up, patients with smaller rotational displacement demonstrated better functional recovery, as reflected by improved Visual Analog Scale (VAS) pain scores and Harris Hip Scores (HHS).The multivariate linear regression analysis demonstrated that the rLWT showed significant correlation with rotational displacement of fracture fragments after intramedullary nail fixation.
Bone rotation and displacement are frequently observed following intramedullary nail fixation for intertrochanteric fractures. The rLWT is closely associated with these complications. Therefore, meticulous attention to surgical technique is essential to minimize complications and optimize outcomes.
使用三维（3D）CT成像量化股骨转子间骨折髓内钉固定后的旋转位移，分析相关危险因素，并评估其临床意义。
本研究纳入了2019年至2023年间接受股骨转子间骨折髓内钉固定的252例患者队列。所有参与者均接受术后三维计算机断层扫描（3D CT），并至少随访1年。对患侧术后股骨前倾角进行定量评估。分析评估其与潜在危险因素的相关性，包括年龄、性别、体重指数（BMI）、美国麻醉医师协会（ASA）分级、髓内钉长度、内固定类型、复位质量、AO基金会/骨创伤协会（AO/OTA）骨折分类、内侧皮质缺损的存在、骨密度（T值）、辛格指数、相对外侧壁厚度（rLWT）、尖顶距（TAD）、颈干角和骨折分类。通过随访评估差异前倾角对长期临床结局的影响，包括视觉模拟量表（VAS）疼痛评分和哈里斯髋关节评分（HHS）。
在筛选排除标准后，共有210例患者纳入研究：33例患者（15.7%）前倾角差异超过15°；177例患者（84.3%）低于15°。在前倾角偏差<15°的亚组中，138例（77.9%）实现了精确的解剖复位（前倾角≤5°），符合最佳生物力学重建目标；39例患者（22.1%）出现功能代偿性旋转不良（5°<前倾角<15°），在步态适应的耐受范围内，无临床损害。单钉固定、内侧皮质缺损、T值>2.5、rLWT和骨折分类被确定为导致旋转位移超过15°的主要因素。在1年随访时，旋转位移较小的患者功能恢复较好，这通过视觉模拟量表（VAS）疼痛评分和哈里斯髋关节评分（HHS）的改善得以体现。多变量线性回归分析表明，rLWT与髓内钉固定后骨折碎片的旋转位移显著相关。
股骨转子间骨折髓内钉固定后经常观察到骨旋转和位移。rLWT与这些并发症密切相关。因此，精心关注手术技术对于尽量减少并发症和优化结局至关重要。
