股骨内侧颈骨折患者经外侧入路闭合复位和动态髋螺钉骨合成术后股骨偏移的变化：回顾性分析

IF 1.8 2区医学 Q2 ORTHOPEDICS Orthopaedic Surgery Pub Date : 2024-10-23 DOI:10.1111/os.14220

Marc-Pascal Meier, Mark-Tilmann Seitz, Dominik Saul, Roland Gera, Paul Jonathan Roch, Katharina Jäckle, Wolfgang Lehmann, Thelonius Hawellek

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引用次数: 0

摘要

目的：对于股骨颈内侧骨折（MFNFs），闭合复位术和动态髋螺钉（DHS）骨合成术是首选的关节保护疗法。股骨偏移量（CFO）的变化可导致步态异常、撞击或大转子疼痛综合征。股骨偏位（FO）能否在术后完全恢复，目前尚不清楚。本研究的目的是调查 DHS 骨合成术后 MFNF 病例中髋关节可能出现 CFO 的程度：在这项回顾性研究中，104 名接受闭合复位和 DHS 骨合成术的 MFNF 患者（平均年龄：71.02 岁，男性：50 人，女性：54 人）通过术后 X 光片进行了分析，以评估手术侧（OS）和非手术侧（NOS）关节的 CFO。研究时间跨度为 2010-2020 年。考虑到患者的年龄、性别和骨折严重程度，对手术侧和非手术侧的FO平均值进行了统计比较：结果：所有接受手术的髋关节都出现了CFO。76.0%（104 例中的 79 例）的 FO 下降（FOD），24.0%（104 例中的 25 例）的 FO 上升（FOI）。52.9%的患者（104 例中有 55 例）检测到临界 CFO（>15% CFO）。在术后出现 FOD 的髋关节中，NOS（49.15 mm [±6.56]）和 OS（39.32 mm [±7.87]）之间的平均 FO 值，而在术后出现 FOI 的髋关节中，NOS（41.59[±8.21]）和 OS（47.27[±6.68]）之间的平均 FO 有显著差异（p S：-0.41；p > 0.001），帽状腱膜-骺端角（CCD；rS：0.34；p > 0.001）与术后 CFO 相关。在术前 FO >44 mm 和 CCD 134° 的髋关节中发现了 FOD：结论：对多发性髋关节炎患者进行闭合复位和 DHS 骨合成术会导致一组显著的 CFO。为避免术后出现大面积 CFO，应在术前和术中考虑个体 FO。

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Change in Femoral Offset after Closed Reduction and Dynamic Hip Screw Osteosynthesis Via Lateral Approach in Patients with Medial Femoral Neck Fracture: A Retrospective Analysis.

Objective: Closed reduction and dynamic hip screw (DHS) osteosynthesis are preferred as joint-preserving therapy in case of medial femoral neck fractures (MFNFs). A change in the femoral offset (CFO) can cause gait abnormality, impingement, or greater trochanteric pain syndrome. It is unknown whether the femoral offset (FO) can be postoperatively fully restored. The aim of the study was to investigate the extent of a possible CFO in hip joints after DHS osteosynthesis in the case of an MFNF.

Methods: In this retrospective study, 104 patients (mean age: 71.02 years, men: n = 50, women: n = 54) with MFNF who underwent closed reduction and DHS osteosynthesis were analyzed by postoperative x-rays to assess CFO between the operated (OS) and nonoperated joint side (NOS). The studies covered the time period 2010-2020. A statistical comparison was performed between the mean values of FO between OS and NOS, taking into account patient age, gender, and fracture severity.

Results: All operated hip joints showed a CFO. In 76.0% (79 of 104), the FO decreased (FOD), and in 24.0% (25 of 104), the FO increased (FOI). A critical CFO (>15% CFO) was detected in 52.9% (55 of 104). In hip joints with postoperative FOD, the mean FO between NOS (49.15 mm [±6.56]) and OS (39.32 mm [±7.87]) and in hip joints with postoperative FOI the mean FO between NOS (41.59 [±8.21]) and OS (47.27 [±6.68]) differed significantly (p < 0.001). Preoperative FO (r_S: -0.41; p > 0.001) and caput-collum-diaphyseal angle (CCD; r_S: 0.34; p > 0.001) correlated with postoperative CFO. FOD was found in hip joints with a preoperative FO >44 mm and CCD <134° vice versa FOI in hip joints with a preoperative FO <44 mm and CCD >134°.

Conclusion: Closed reduction and DHS osteosynthesis in patients with MFNF result in a clustered significant CFO. The individual FO should be taken into account pre- and intraoperatively to avoid a postoperative extensive CFO.

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来源期刊

Orthopaedic Surgery ORTHOPEDICS-

CiteScore

3.40

自引率

14.30%

发文量

374

审稿时长

20 weeks

期刊介绍： Orthopaedic Surgery (OS) is the official journal of the Chinese Orthopaedic Association, focusing on all aspects of orthopaedic technique and surgery. The journal publishes peer-reviewed articles in the following categories: Original Articles, Clinical Articles, Review Articles, Guidelines, Editorials, Commentaries, Surgical Techniques, Case Reports and Meeting Reports.