Zhang Binquan, Huo Jia, Li Huijie
Department of Orthopedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China.
Front Med (Lausanne). 2025 Aug 14;12:1637763. doi: 10.3389/fmed.2025.1637763. eCollection 2025.
The impact of fracture reduction quality on clinical outcomes in hip arthroplasty for intertrochanteric fractures remains insufficiently characterized. This study aimed to establish a standardized postoperative radiographic evaluation system for reduction quality and assess its correlation with postoperative function and complications.
A retrospective cohort study included 237 patients undergoing hip arthroplasty for intertrochanteric fractures (2012-2024). Reduction quality was classified as optimal, acceptable, or poor based on four criteria: (1) greater trochanter alignment, (2) lesser trochanter reduction, (3) femoral stem stability, and (4) postoperative femoral anteversion (optimal: 13 ± 3°; acceptable: 6-10° or 16-20°; poor: <6° or >20°). Outcomes included Harris Hip Scores, Engh's scores, delayed healing, and complications. Statistical analyses were adjusted for AO/OTA fracture classification.
Optimal reduction (Grade A, = 107) correlated with superior Harris Hip Scores (92.57 ± 4.27 vs. 82.46 ± 7.05, < 0.001), lower delayed healing (3.74% vs. 14.29%, = 0.031), and reduced abductor weakness (1.87% vs. 14.29%, = 0.014). Acceptable reductions (Grade B, = 74) showed intermediate outcomes. Poor reductions (Grade C, = 56) exhibited the highest complication rates. Engh's scores were significantly higher in Grade A (97.20% vs. 73.21%, = 0.002). Dislocation and heterotopic ossification rates did not differ significantly ( > 0.05).
This study introduced and validated a standardized radiographic evaluation system to assess reduction quality in arthroplasty for intertrochanteric fractures, emphasizing the prognostic importance of anatomic trochanteric alignment and cortical continuity. High-quality reduction is critical for optimizing functional recovery and minimizing complications in arthroplasty for intertrochanteric fractures. Future research should explore long-term outcomes and advanced fixation techniques to enhance reduction precision.
在转子间骨折髋关节置换术中，骨折复位质量对临床结果的影响仍未得到充分描述。本研究旨在建立一个标准化的术后影像学评估系统来评估复位质量，并评估其与术后功能及并发症的相关性。
一项回顾性队列研究纳入了237例接受转子间骨折髋关节置换术的患者（2012年至2024年）。根据以下四项标准将复位质量分为优、可接受或差：（1）大转子对线；（2）小转子复位情况；（3）股骨干稳定性；（4）术后股骨前倾角（优：13±3°；可接受：6 - 10°或16 - 20°；差：<6°或>20°）。结果包括Harris髋关节评分、Engh评分、延迟愈合及并发症。统计分析对AO/OTA骨折分类进行了校正。
优复位（A级，n = 107）与更高的Harris髋关节评分相关（92.57±4.27对82.46±7.05，P < 0.001），更低的延迟愈合发生率（3.74%对14.29%，P = 0.031），以及更低的外展肌无力发生率（1.87%对14.29%，P = 0.014）。可接受复位（B级，n = 74）显示出中等结果。差复位（C级，n = 56）表现出最高的并发症发生率。A级的Engh评分显著更高（97.20%对73.21%，P = 0.002）。脱位和异位骨化发生率无显著差异（P>0.05）。
本研究引入并验证了一个标准化的影像学评估系统，以评估转子间骨折置换术中的复位质量，强调了解剖学转子对线和皮质连续性的预后重要性。高质量复位对于优化转子间骨折置换术的功能恢复和最小化并发症至关重要。未来的研究应探索长期结果和先进的固定技术，以提高复位精度。
