股骨大转子骨折治疗的临床结果:一项回顾性队列研究。

IF 3 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Cesare Donadono, Domenico Tigani, Andrea Assenza, Davide Censoni, Francesco Pesce, Giuseppe Melucci
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引用次数: 0

摘要

背景:股骨近端股骨粗隆骨折对创伤学家来说是一个共同的挑战,髓内钉是首选的治疗方法。并发症发生率约为20%,包括螺钉卡壳、再骨折、假体断裂或内侧移位,其中切出最为常见。尖端距(TAD)约为25mm,头侧螺钉位置不正确是切口的预测因素。本研究基于博洛尼亚Ospedale Maggiore骨科和创伤科的经验,评估了使用Elos髓内钉的结果。方法:我们对2017年1月1日至2022年12月31日使用Elos髓内钉治疗股骨粗隆骨折的344例患者进行了回顾性队列研究。采用标准技术植入Elos®-Intrauma指甲。最初的x光片根据AO-OTA分类对骨折进行分类,术后x光片确认头侧螺钉按克利夫兰区放置。患者分为两组:最佳头侧螺钉位(位置5-8-9)和其他位置。我们使用Chang的标准评估TAD、calcar- reference TAD (CalTAD)和术后复位质量。通过这些测量来评估切口和其他并发症的发生率。结果:344例患者中,螺钉放置在5 ~ 8 ~ 9位227例(65.9%),其他位置117例(34.1%)。中位TAD为19.47±6.26 mm(范围3.96 ~ 46.6),265例(77%)患者TAD≤25 mm。中位CalTAD为22.37±5.65 mm(范围8.75-45.3),其中231例(67.1%)患者CalTAD≤25 mm。根据Chang的标准,复位差8例(2.3%),复位可接受139例(40.4%),复位优197例(57.3%)。切出4例(1.19%)。多因素分析显示,复位不良和TAD bbb25 mm是切断发生率的独立预测因素(p < 0.05),而头侧螺钉位置、CalTAD和骨折类型对切断发生率没有影响。结论:本研究表明,最佳的TAD和复位质量对于最小化切出风险至关重要。当满足这些参数时,Elos髓内钉显示出良好的效果,切口发生率低。重点应放在达到TAD≤25mm和良好的复位质量,以减少并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical Outcomes in the Treatment of Pertrochanteric Femur Fractures: A Retrospective Cohort Study.

Background: Pertrochanteric fractures of the proximal femur present a common challenge for traumatologists, with intramedullary nailing emerging as the preferred treatment. Complication rates are around 20%, including screw jamming, refractures, implant breakage, or medial migration, with cut-out being the most common. A tip-apex distance (TAD) of >25 mm and incorrect cephalic screw position are predictive factors for cut-out. This study assesses outcomes using the Elos intramedullary nail, based on the experience of the Department of Orthopedics and Traumatology at Ospedale Maggiore in Bologna. Methods: We conducted a retrospective cohort study of 344 patients treated with the Elos intramedullary nail for pertrochanteric femoral fractures from 1 January 2017 to 31 December 2022. The Elos®-Intrauma nail was implanted using the standard technique. Initial X-rays classified fractures according to the AO-OTA classification, and postoperative X-rays confirmed the cephalic screw's placement per Cleveland's regions. Patients were divided into two groups: optimal cephalic screw position (positions 5-8-9) and other positions. We evaluated TAD, calcar-referred TAD (CalTAD), and postoperative reduction quality using Chang's criteria. The incidence of cut-out and other complications were assessed in connection with these measurements. Results: Among the 344 patients, 227 (65.9%) had the screw in positions 5-8-9, while 117 (34.1%) had it in other positions. The median TAD was 19.47 ± 6.26 mm (range 3.96-46.6), with TAD ≤ 25 mm in 265 patients (77%). The median CalTAD was 22.37 ± 5.65 mm (range 8.75-45.3), with CalTAD ≤ 25 mm in 231 patients (67.1%). According to Chang's criteria, 8 cases (2.3%) had poor reduction, 139 cases (40.4%) had acceptable reduction, and 197 cases (57.3%) had excellent reduction. Cut-out occurred in four cases (1.19%). Multivariate analysis revealed only poor reduction and TAD > 25 mm as independent predictors of cut-out (p < 0.05), while cephalic screw position, CalTAD, and fracture type did not impact cut-out incidence. Conclusions: This study indicates that optimal TAD and quality of reduction are crucial for minimizing cut-out risks. The Elos intramedullary nail shows favorable outcomes with a low cut-out incidence when these parameters are met. Emphasis should be placed on achieving a TAD ≤ 25 mm and excellent reduction quality to reduce complications.

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来源期刊
Journal of Personalized Medicine
Journal of Personalized Medicine Medicine-Medicine (miscellaneous)
CiteScore
4.10
自引率
0.00%
发文量
1878
审稿时长
11 weeks
期刊介绍: Journal of Personalized Medicine (JPM; ISSN 2075-4426) is an international, open access journal aimed at bringing all aspects of personalized medicine to one platform. JPM publishes cutting edge, innovative preclinical and translational scientific research and technologies related to personalized medicine (e.g., pharmacogenomics/proteomics, systems biology). JPM recognizes that personalized medicine—the assessment of genetic, environmental and host factors that cause variability of individuals—is a challenging, transdisciplinary topic that requires discussions from a range of experts. For a comprehensive perspective of personalized medicine, JPM aims to integrate expertise from the molecular and translational sciences, therapeutics and diagnostics, as well as discussions of regulatory, social, ethical and policy aspects. We provide a forum to bring together academic and clinical researchers, biotechnology, diagnostic and pharmaceutical companies, health professionals, regulatory and ethical experts, and government and regulatory authorities.
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