Reliability of Predictors for Screw Cutout in Intertrochanteric Hip Fractures
Reliability of Predictors for Screw Cutout in Intertrochanteric Hip Fractures
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DOI：
10.2106/jbjs.k.00357
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发表时间：
2012-07-18
影响因子：
5.3
通讯作者：
Roukema, Gert
中科院分区：
文献类型：
--
作者：
De Bruijn, Kirstin;den Hartog, Dennis;Roukema, Gert
背景：股骨转子间髋部骨折内固定后，尖端顶点距离、骨折分类、螺钉在股骨头中的位置以及骨折复位是螺钉切除的已知预测因素，但这些测量的可靠性尚不清楚。我们研究了尖端距离测量、克利夫兰股骨头划分系统、Baumgaertner 骨折复位三级分类系统以及 AO 分类系统作为螺钉切除预测因素的可靠性。方法：根据我们的髋部创伤数据库对 2007 年 1 月至 2010 年 6 月期间使用动态髋螺钉或伽马钉治疗的所有股骨粗隆间骨折患者进行评估。结果：尖端距离测量可靠，患者带有设备切口的尖端顶点距离明显更高。观察者之间关于螺钉位置和骨折复位的一致性具有中等可靠性。调整尖端距离和螺钉位置后，与 A1 骨折相比，A3 骨折发生切除的风险更大。在单变量分析中，骨折复位不良与较高的截断发生率显着相关，但在多变量分析中则不然。调整尖端顶点距离和螺钉位置后，中下和前下位置可显着防止切口。结论：为了降低可能的切口风险，尖端顶点距离需要保持较小或螺钉需要放置在中下或前下。证据级别：治疗级别 III。有关证据级别的完整描述，请参阅作者须知。
Background: Following internal fixation of intertrochanteric hip fractures, tip apex distance, fracture classification, position of the screw in the femoral head, and fracture reduction are known predictors for screw cutout, but the reliability of these measurements is unknown. We investigated the reliability of the tip apex distance measurement, the Cleveland femoral head dividing system, the three-grade classification system of Baumgaertner for fracture reduction, and the AO classification system as predictors for screw cutout.Methods: All patients with an intertrochanteric hip fracture who were managed with either a dynamic hip screw or a gamma nail between January 2007 and June 2010 were evaluated from our hip trauma database.Results: The tip apex distance measurement was reliable and patients with device cutout had a significantly higher tip apex distance. The agreement between observers with regard to screw position and fracture reduction was moderately reliable. After adjustment for tip apex distance and screw position, A3 fractures were at more risk of cutout compared with A1 fractures. Poor fracture reduction was significantly related with a higher incidence of cutout in univariate analysis, but not in multivariate analysis. Central-inferior and anterior-inferior positions, after adjustment for tip apex distance and screw position, were significantly protective against cutout.Conclusion: To decrease probable risks of cutout, the tip apex distance needs to stay small or the screw needs to be placed central-inferiorly or anterior-inferiorly.Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.