摘要
目的通过比较亚洲型股骨近端髓内钉(Asian type proximal femoral nail,APFN)治疗股骨转子间骨折时,不同尖顶距(tip-apex distance,TAD)和股距尖顶距(calcar referenced tip-apex distance,Cal-TAD)患者间手术并发症发生情况,探讨上述两种概念对股骨转子间骨折术后并发症的预测价值。方法以2014年1月—2018年12月采用APFN治疗且符合选择标准的188例股骨转子间骨折患者作为研究对象,于术后即刻X线片测量TAD和Cal-TAD,并根据测量结果将其分别分为<25 mm及≥25 mm两组。记录患者性别、年龄、骨折侧别及AO分型;患者术后12个月内并发症发生情况,包括骨折延迟愈合或不愈合、螺旋刀片轴向移动、股骨颈内翻塌陷或螺旋刀片向上切出、内固定物松动或断裂;然后进行统计分析。结果188例患者中TAD<25 mm 119例、≥25 mm 69例,Cal-TAD<25 mm 142例、≥25 mm 46例。TAD<25 mm、≥25 mm组间以及Cal-TAD<25 mm、≥25 mm组间患者性别、年龄、骨折侧别及AO分型差异均无统计学意义(P>0.05)。随访期间,TAD<25 mm组6例(5.04%)、≥25 mm组10例(14.49%)发生并发症,Cal-TAD<25 mm组1例(0.70%)、≥25 mm组15例(32.61%)发生并发症;不同TAD患者间、不同Cal-TAD患者间,以及TAD<25 mm与Cal-TAD<25 mm患者间并发症发生率比较,差异均有统计学意义(P<0.05)。结论APFN内固定治疗股骨转子间骨折术中,TAD或Cal-TAD控制在25 mm以内均可明显减少手术并发症,Cal-TAD对于术后并发症的预测价值更大。
Objective To compare the predictive value of the two concepts for complications by comparing the incidences of surgical complications associated with different tip-apex distance(TAD)and calcar referenced tip-apex distance(Cal-TAD)in the treatment of femoral intertrochanteric fractures with Asian type proximal femoral nail(APFN)fixation.Methods A total of 188 cases of femoral intertrochanteric fractures treated with APFN fixation between January 2014 and December 2018 were collected according to inclusion criteria.TAD and Cal-TAD were measured on the X-ray film at immediate after operation;the patients were divided into two groups according to the measurement results:<25 mm and≥25 mm.Gender,age,and fracture side and AO type were recorded.The patients in each group were reviewed whether there was delayed fracture union or nonunion,whether the screw blade moved axially,whether the femoral neck collapsed or even screw blade cut out,whether the internal fixator became loose or broken within 12 months after operation.Then statistical analysis was performed.Results There were 119 patients with TAD<25 mm and 69 patients with TAD≥25 mm,and 142 patients with Cal-TAD<25 mm and 46 patients with Cal-TAD≥25 mm.There was no significant difference in gender,age,or fracture side and AO type between groups(P>0.05).During the follow-up,6 patients(5.04%)with TAD<25 mm,10 patients(14.49%)with TAD≥25 mm had complications,and 1 patient(0.70%)with Cal-TAD<25 mm and 15 patients(32.61%)with Cal-TAD≥25 mm had complications.There were significant differences in the incidence of complication between the patients with different TAD,between the patients with different Cal-TAD,and between patients with TAD<25 mm and Cal-TAD<25 mm(P<0.05).Conclusion In the operation of femoral intertrochanteric fracture with APFN fixation,surgical complications can be significantly reduced when TAD or Cal-TAD was controlled within 25 mm,Cal-TAD is more significant in the prediction of postoperative complications.
作者
蔡雨卫
冯俊涛
陈羽
史萌
俞仲翔
房雷
周琳
徐盛明
CAI Yuwei;FENG Juntao;CHEN Yu;SHI Meng;YU Zhongxiang;FANG Lei;ZHOU Lin;XU Shengming(Department of Orthopaedics,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai,201203,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第11期1359-1363,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
股骨转子间骨折
亚洲型股骨近端髓内钉
尖顶距
股距尖顶距
内固定
并发症
Femoral intertrochanteric fracture
Asian type proximal femoral nail
tip-apex distance
calcarreferenced tip-apex distance
internal fixation
complication
