Harris L J
Instr Course Lect. 1983;32:292-303.
The use of a closed nailing technique for elderly patients with intertrochanteric fractures has resulted in a substantially improved mortality. The incidence of fixation failures and degree of shortening are similar to that experienced with sliding screw and sliding nail plate systems. However, since rotational deformities may occur, the procedure is most beneficial for debilitated patients with intertrochanteric fractures, who represent substantial surgical risks. In general, subtrochanteric fractures occur in a younger group of patients. Since the proximal fragment is usually much larger and the quality of bone superior in this group of patients, the fixation failure rate was extremely low and significant loss of rotatory reduction did not occur. The body of experience gained in recent years with closed nailing techniques for femoral shaft and tibial fractures is directly applicable to the closed nailing of intertrochanteric and subtrochanteric fractures. Extremely comminuted fractures or long oblique fractures may shorten, and rotatory reduction and control must always be a concern. These difficulties must be weighed against the advantages of a negligible infection rate and extremely low nonunion and implant failure rates.
对于老年转子间骨折患者采用闭合穿钉技术已显著降低了死亡率。固定失败的发生率和缩短程度与滑动螺钉及滑动钉板系统相似。然而，由于可能发生旋转畸形，该手术对患有转子间骨折的体弱患者最为有益，这类患者存在较大的手术风险。一般来说，转子下骨折发生在较年轻的患者群体中。由于该组患者的近端骨折块通常大得多且骨质较好，固定失败率极低，且未出现明显的旋转复位丢失。近年来在股骨干和胫骨干骨折闭合穿钉技术方面积累的经验可直接应用于转子间和转子下骨折的闭合穿钉。极粉碎性骨折或长斜形骨折可能会缩短，旋转复位和控制始终是需要关注的问题。必须将这些困难与感染率可忽略不计、骨不连和植入物失败率极低的优势相权衡。
