Saito N, Miyasaka T, Toriumi H
Department of Orthopaedic Surgery, Suwa Red Cross Hospital, Nagano, Japan.
Arch Orthop Trauma Surg. 1995;114(4):183-7. doi: 10.1007/BF00444259.
After 82 patients underwent osteosynthesis with multiple pinning for a displaced intracapsular femoral neck fracture, 58 fractures were united, and 24 were not. These 82 patients were included in a discriminant analysis. Union and non-union groups were the dependent variables. Eleven presumably predictive factors measured on X-ray films obtained from these patients before and immediately after operation were taken as independent variables. Three radiographic factors were selected by a stepwise method according to the effect they had on union. These were: the distance of medial displacement between fragments before reduction; the varus angle after reduction; and the distance of medial displacement between fragments after reduction. The distance of medial displacement between fragments before reduction proved the most important factor in making a choice between osteosynthesis and primary arthroplasty, and it was revealed that osteosynthesis could not be expected to provide union if the distance was 20 mm or more. It was also confirmed that union was promoted, if the cranial fragment was reduced to a valgus position and the medial cortical bones were aligned as much as possible at the time of osteosynthesis.
82例患者因股骨颈囊内移位骨折接受多枚钢针内固定术后，58例骨折愈合，24例未愈合。这82例患者被纳入判别分析。愈合组和未愈合组为因变量。从这些患者术前及术后即刻的X线片上测量的11个可能的预测因素作为自变量。根据对骨折愈合的影响，通过逐步法选择了三个影像学因素。它们是：复位前骨折块内侧移位距离；复位后内翻角度；复位后骨折块内侧移位距离。复位前骨折块内侧移位距离被证明是在选择内固定和一期关节成形术时最重要的因素，并且发现如果该距离为20mm或更大，则不能期望内固定实现骨折愈合。还证实，在进行内固定时，如果将近端骨折块复位到外翻位置并且尽可能使内侧皮质骨对齐，则可促进骨折愈合。
