Gundle R, Gargan M F, Simpson A H
Trauma Service, John Radcliffe Hospital, Oxford, UK.
Injury. 1995 Nov;26(9):611-4. doi: 10.1016/0020-1383(95)00125-s.
Sliding hip screws have improved the treatment of unstable intertrochanteric hip fractures and their success, compared with fixed devices, is in large part due to the sharing of load between the implant and the fracture fragments. In a prospective study of 100 patients with such fractures, five factors concerned with the fracture and its fixation were studied and odds ratios calculated of their relative importance in prediction of failure. The most important factor affecting the load borne by the fracture fragments was the amount of slide available within the device, and that affecting the load carried by the device was the position of the screw in the femoral head. For fractures fixed with a device allowing less than 10 mm of slide, and those with superior screw position, the risk of failure was increased by factors of 3.2 and 5.9, respectively. Anatomical reduction alone, rather than osteotomy, together with sliding hip screw fixation, has been recommended for these fractures in three prospective randomized trials. It is calculated here that to allow sufficient slide when employing this technique, it is essential to use a short barrel device when using dynamic screws of 85 mm or less. This has not been demonstrated before.
与固定装置相比，滑动髋螺钉改善了不稳定型股骨转子间髋部骨折的治疗效果，其成功很大程度上归功于植入物与骨折碎片之间的负荷分担。在一项针对100例此类骨折患者的前瞻性研究中，研究了与骨折及其固定相关的五个因素，并计算了它们在预测失败方面相对重要性的比值比。影响骨折碎片承受负荷的最重要因素是装置内可用的滑动量，而影响装置承载负荷的因素是螺钉在股骨头中的位置。对于使用滑动量小于10毫米的装置固定的骨折以及螺钉位置较高的骨折，失败风险分别增加了3.2倍和5.9倍。三项前瞻性随机试验建议，对于这些骨折，应采用单纯解剖复位而非截骨术，并结合滑动髋螺钉固定。据计算，在采用该技术时，为了留出足够的滑动空间，使用85毫米或更短的动力螺钉时，必须使用短套筒装置。此前尚未证实这一点。
