股骨转子间骨折伴有滞后螺钉插入部位的侧壁骨折，可能会导致术后前壁骨折，导致日常生活能力下降。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science Pub Date : 2025-03-01 DOI:10.1016/j.jos.2024.06.004

Takuji Matsumoto , Shuzo Nakatani , Katsuhide Inoue , Yuko Michiue , Ikuko Matsumoto , Nobuhiko Funaoka

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引用次数: 0

摘要

背景：股骨转子间骨折的不完全复位和固定严重影响患者的日常活动。在此类骨折中，侧壁的完整性至关重要。本研究探讨了不稳定性，尤其是滞后螺钉插入部位的侧壁骨折和术后前壁骨折：方法：共纳入 161 例股骨转子间骨折患者。方法：共纳入161例股骨转子间骨折患者，术前和术后3周进行三维计算机断层扫描，以确定术后前壁骨折的发生率。比较了患者背景、手术时间、术中失血量、术后伸缩性和日常生活活动：研究记录了 51 例在滞后螺钉插入部位发生的侧壁骨折和 17 例术后前壁骨折。在无滞后螺钉插入部位组和有滞后螺钉插入部位组的 110 例患者中，分别有 3 例和 14 例术后前壁骨折。术后前壁骨折组的骨质密度明显较低，手术时间较长，术中失血量增加。术后4周时，前壁骨折组的伸缩性增加，功能独立性测量中的运动部分减少（前壁骨折组：28，无前壁骨折组：30）：在显示下肢功能的转移和运动项目中，观察到明显的减少（前壁骨折术后组：11，前壁骨折术后组：30）：前壁骨折术后组：11；前壁骨折术后未骨折组：12）：结论结论：术后前壁骨折发生率为 27.5%，侧壁骨折发生在滞后螺钉插入部位。三维计算机断层扫描有助于术前评估滞后螺钉插入部位的侧壁骨折，以评估不稳定性。需要注意的是，术后前壁骨折会导致日常生活活动能力下降。

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Intertrochanteric femoral fracture with lateral wall fracture at the lag screw insertion site may cause postoperative anterior wall fracture and lead to deterioration in activities of daily living

Background

Incomplete reduction and fixation of intertrochanteric femoral fractures significantly affect patients' daily activities. The lateral wall's integrity is pivotal in such fractures. This study examines instability, particularly lateral wall fractures at the lag screw insertion site and postoperative anterior wall fractures.

Methods

Overall, 161 patients with femoral intertrochanteric fractures were included. Three-dimensional computed tomography was conducted preoperatively and 3 weeks postoperatively to determine the postoperative anterior wall fractures incidence. Patient background, operative time, intraoperative blood loss, postoperative telescoping, and daily living activities were compared.

Results

The study recorded 51 cases of lateral wall fractures at the lag screw insertion site and 17 of postoperative fractures of the anterior wall. Postoperative fractures of the anterior wall were found in 3 of 110 and 14 of 51 patients in the group without and with the lag screw insertion site, respectively. The group of postoperative fractures of the anterior wall had significantly lower bone mineral density, longer operative time, and increased intraoperative blood loss. At 4 weeks postoperatively, the group of postoperative fractures of the anterior wall showed increased telescoping and decreased motor component of the functional independence measure (with postoperative fractures of the anterior wall: 28, without postoperative fractures of the anterior wall: 30), and significant reductions were observed in the transfer and locomotion items, indicating lower limb function (with postoperative fractures of the anterior wall group: 11, without postoperative fractures of the anterior wall group: 12).

Conclusions

Postoperative anterior wall fractures occurred in 27.5% cases with lateral wall fractures at the lag screw insertion site. Three-dimensional computed tomography is useful for preoperative evaluation of lateral wall fractures at the lag screw insertion site to assess instability. Postoperative fractures of the anterior wall related reduction in daily living activities needs attention.

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来源期刊

Journal of Orthopaedic Science 医学-整形外科

CiteScore

3.00

自引率

0.00%

发文量

290

审稿时长

90 days

期刊介绍： The Journal of Orthopaedic Science is the official peer-reviewed journal of the Japanese Orthopaedic Association. The journal publishes the latest researches and topical debates in all fields of clinical and experimental orthopaedics, including musculoskeletal medicine, sports medicine, locomotive syndrome, trauma, paediatrics, oncology and biomaterials, as well as basic researches.