Jarrett P J, Fleming L L, Whitesides T E
Instr Course Lect. 1984;33:203-18.
Most series found in the literature on peritrochanteric fractures report failure rates of 9% to 35% for nonsliding fixation and 5% to 12% for devices that allow collapse about the axis of the barrel of the device, indicating that the concept of load sharing is a valid principle in the management of these injuries. Reviewing our experience with the fully collapsible devices reveals a remarkably low incidence of complications related to both metal failure and postoperative penetration of the femoral head. Most of the failures in our series occurred before the routine use of fluoroscopic operative placement control and can be related to inadvertent intraoperative penetration of the femoral head. With modern techniques, therefore, these complications are largely preventable. Despite those failures, which cannot be explained by technical error, we are extremely pleased with our overall results because the fully collapsible devices appear to allow early weight bearing without fear of fixation complications, even in unstable fractures. This concept allows for easier postoperative rehabilitation and attendant diminished mortality rates as compared with other devices currently used. Although no study can conclusively demonstrate the clear superiority of the slotted Richards screw and Ken-Pugh nail over other forms of sliding fixation, we believe that if the concept of load sharing is valid, this modification is a simple, sensible, and effective addition to most nail plate devices used today.
文献中关于转子周围骨折的大多数系列研究报告称，非滑动固定的失败率为9%至35%，而允许沿装置杆轴塌陷的器械的失败率为5%至12%，这表明负荷分担的概念在这些损伤的治疗中是一个有效的原则。回顾我们使用完全可塌陷器械的经验发现，与金属失效和股骨头术后穿透相关的并发症发生率极低。我们系列中的大多数失败发生在常规使用透视手术放置控制之前，可能与术中意外穿透股骨头有关。因此，采用现代技术，这些并发症在很大程度上是可以预防的。尽管存在那些无法用技术失误解释的失败情况，但我们对总体结果非常满意，因为完全可塌陷器械似乎允许早期负重，而不用担心固定并发症，即使是在不稳定骨折中也是如此。与目前使用的其他器械相比，这一概念使术后康复更容易，随之死亡率降低。虽然没有研究能够确凿地证明开槽理查兹螺钉和肯 - 普格钉比其他形式的滑动固定具有明显优势，但我们认为，如果负荷分担的概念是有效的，那么这种改进对于当今使用的大多数钉板器械来说是一种简单、合理且有效的补充。
