Kawaguchi S, Sawada K, Nabeta Y
Nikko Memorial Hospital, Muroran, Japan.
Injury. 1998 Jan;29(1):47-53. doi: 10.1016/s0020-1383(97)00158-7.
Sixty consecutive intertrochanteric femoral fractures were treated with the Asiatic gamma nail followed by early postoperative weight bearing. Cutting-out of the lag screw from the femoral head occurred in six fractures and were analysed radiographically with regard to fracture type (Evans' classification), osteoporosis (Singh grade), accuracy of post-operative reduction (neck-shaft angle and diastasis of the fracture), and location of the lag screw in the femoral head (depth, height, and antero-postero-posterior radiograph and large antero-posterior deviation of the lag screw were significantly related to the increased incidence of the screw cutting-out. This suggests that deep insertion of the lag screw on the antero-posterior view with central placement on the lateral view is an optimal location in the femoral head. The ¿cut-out index' (the multiplication value of the depth and the anteroposterior deviation of the lag screw in the femoral head) is an excellent measure of the risk of the lag screw cutting-out.
连续60例股骨转子间骨折采用亚洲伽马钉治疗，并于术后早期负重。6例骨折出现拉力螺钉从股骨头切出的情况，并根据骨折类型（Evans分类）、骨质疏松（Singh分级）、术后复位准确性（颈干角和骨折分离）以及拉力螺钉在股骨头中的位置（深度、高度、前后位X线片以及拉力螺钉的大前后位偏差与螺钉切出发生率增加显著相关。这表明在前后位X线片上拉力螺钉深插入且在侧位片上位于中心位置是股骨头的最佳位置。“切出指数”（拉力螺钉在股骨头中的深度与前后位偏差的乘积值）是衡量拉力螺钉切出风险的极佳指标。
