股骨粗隆间骨折植骨治疗的固定稳定性评分:一项回顾性观察研究

Pradeep H, Venkatesh V, Kambam Gowtham Reddy, Markandaiya Acharya
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引用次数: 0

摘要

目的探讨新提出的固定稳定性评分系统在IT骨折植骨治疗中的有效性及其局限性。回顾性分析2021年1月至2022年8月在图木库尔悉达多医学院接受手术治疗的各种类型转子间骨折患者的住院记录。排除标准为跌倒前未卧床的患者、未接受手术治疗的患者、未随访的患者或研究时死亡的患者。评分由三名不同的观察者完成,每隔1个月进行一次术后x线检查。最后随访时的x线片评估骨折愈合或固定失败。评分系统参数:1)正位片皮质支撑,2)侧位片皮质支撑,3)主滞后螺钉尖端尖端距离(TAD), 4)入钉点(IM钉),5)主螺钉尖端在理想Cleveland区位置。6)在颈部下半部分放置Richard螺钉(DHS), 7)使用额外的旋转螺钉(DRS) (DHS)。所有观察者的得分均与固定失败率有统计学上的显著相关。7.5分及以上为良好,6.5分及以上为一般,6.5分以下为较差。髓外装置的最低可接受评分为6.5分,髓内装置为7分。新提出的评分系统似乎是有效和有希望的术中指导转子间骨折的固定,但有一些局限性。未来需要大规模的多中心前瞻性研究来支持当前的研究或进一步简化该评分系统。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Fixation stability scoring in inter-trochanteric femur fractures treated with osteosynthesis: A retrospective observational study
To find out the validity of a newly proposed fixation stability scoring system in IT fractures treated with osteosynthesis and its limitations if any.: Retrospective analysis of hospital records of patients with various types of intertrochanteric fractures treated surgically at Sri Siddhartha medical college, Tumkur from January 2021 till August 2022. The exclusion criteria were non-ambulatory patients prior to fall, non surgically treated patients, patients loosing follow up or patients who are not alive at the time of study. The scoring was done by three different observers for each patient’s immediate post operative x-ray, repeated at 1 month interval. Radiographs at the final follow up were assessed for fracture union or fixation failure. Parameters of the scoring system: 1) cortical buttress in AP view radiograph, 2) cortical buttress in lateral view radiograph, 3) Tip apex distance (TAD) of principle lag screw, 4) Entry point (in case of IM nail), 5) Location of tip of principle screw in the desired Cleveland zone. 6) Placement of Richard screw in the inferior half of neck (in case of DHS), 7) Use of additional derotation screw (DRS) (in case of DHS). Scores of all the observers showed statistically significant correlation with fixation failure rates. Results were good with the score of 7.5 and above, fair with 6.5 and above and poor when the score was below 6.5. The minimum acceptable score was 6.5 for extra-medullary devices and 7 for intra-medullary devices.: The newly proposed scoring system appears to be valid and promising intra operative guide for fixation of intertrochanteric fractures with a few limitations. Large scale multi centre prospective studies are needed in the future to support the current study or to further simplify this scoring system.
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