Yoshimine F, Latta L L, Milne E L
Department of Orthopaedics and Rehabilitation, University of Miami School of Medicine, Florida.
J Orthop Trauma. 1993;7(4):348-53. doi: 10.1097/00005131-199308000-00011.
Sliding of compression hip screws (CHS) is advantageous when it allows for controlled collapse of a hip fracture and progressive stabilization. A retrospective review was performed on 47 intertrochanteric (IT) fractures treated with a Zimmer CHS. Previous studies had identified certain parameters as being important to CHS sliding characteristics in vitro. Using conventional diagnostic material (radiographs), we sought to use these parameters as clinically useful tools. Screw sliding, as well as geometric parameters of CHS that relate to screw sliding, such as barrel engagement in relation to screw extension and screw-plate angle, were measured and calculated from serial radiographs. Almost all screw sliding occurred within 30 days postoperation. Fracture stability and quality of reduction were two main factors relating to screw sliding (p < 0.01). High screw-plate angle and longer screw-barrel engagement had no correlation with screw sliding even in unstable fractures. All five failures were due to cut-out after complete or almost complete collapse of the sliding mechanism in non-anatomically reduced fractures in osteoporotic females. Unstable fractures in osteoporotic bone do seem to require supplementary fixation beyond sliding screw fixation alone. None of the mechanical parameters (as judged from plane radiographs) that control the tendency of the CHS to slide could be statistically correlated with incidence or degree of sliding. Therefore, it was concluded that it is impractical to attempt to predict sliding tendency from plane radiograph measurements.
加压髋螺钉（CHS）的滑动具有优势，因为它能使髋部骨折得到可控的塌陷并逐步实现稳定。对47例采用 Zimmer CHS 治疗的转子间（IT）骨折进行了回顾性研究。以往研究已确定某些参数对 CHS 在体外的滑动特性很重要。我们利用传统诊断材料（X 光片），试图将这些参数用作临床实用工具。从系列 X 光片中测量并计算螺钉滑动以及与螺钉滑动相关的 CHS 几何参数，如套筒与螺钉延伸的关系以及螺钉 - 钢板角度。几乎所有螺钉滑动都发生在术后30天内。骨折稳定性和复位质量是与螺钉滑动相关的两个主要因素（p < 0.01）。即使在不稳定骨折中，高螺钉 - 钢板角度和较长的螺钉 - 套筒结合与螺钉滑动也无相关性。所有5例失败均是由于骨质疏松女性非解剖复位骨折的滑动机制完全或几乎完全塌陷后出现的螺钉穿出。骨质疏松性骨的不稳定骨折似乎确实需要在单纯滑动螺钉固定之外进行补充固定。控制 CHS 滑动趋势的机械参数（从平面 X 光片判断）均与滑动发生率或程度无统计学相关性。因此，得出结论，试图通过平面 X 光片测量来预测滑动趋势是不切实际的。
