- 期刊
Optimal Location of Lag Screw of Dynamic Hip Screw in Femoral Head during Treating Unstable Intertrochanteric Fractures in Elderly Patients
利用Dynamic Hip Screw治療老人不穩定轉子間骨折：探討Lag Screw在股骨頭中之最佳位置
並列摘要
Background: Intertrochanteric fractures in elderly patients are common and the sliding compression screw (SCS) is a widely used device for treatment. In the literature, two locations in the femoral head are preferred for lag screw placement and none is absolutely superior. Materials and methods: One hundred and nine consecutive unstable intertrochanteric fractures (OTA, Orthopedic Trauma Association, A21 or A22) in elderly patients (≥65 years) were treated with the SCS and followed-up for at least 6 months. The lag screw of the SCS was placed in the central-central area in both anteroposterior and lateral radiograph in 72 femoral heads and inferior 1/3-central, in other 37 femoral heads. Postoperatively, ambulation with protected weight bearing was encouraged as early as possible. The clinical fracture healing process and migration of the lag screw in the femoral head were investigated. Results: Patients were followed-up immediately postoperatively, one month, three months, and six months. In the central-central group, one lag screw (1/72) cut out at six months and no lag screw (0/37) cut out in the inferior 1/3-central group (p=0.66). For the tip-apex distance (TAD), in the central-central group, 16.0±3.8 mm, 15.9±3.8 mm, 16.7±4.4 mm, and 16.3±3.9 mm, respectively (p=0.66) was achieved in the subsequence of follow-up. In the inferior 1/3-central group, 25.8±3.4 mm, 25.4±3.2 mm, 25.0±3.6 mm, and 25.2±3.9 mm, respectively (p=0.80) was achieved in the subsequence of follow-up. For vertical migration, in the central-central group, an average of 0.4 mm, 0.4 mm, and 0.2 mm, respectively (p=0.02) was observed in the subsequence of follow-up. In the inferior 1/3-central group, an average of 0.1 mm, 0.3 mm, and 0.1 mm, respectively (p=0.77) was observed in the subsequence of follow-up. Conclusion: Clinically, both locations are suitable for lag screw placement. The TAD is unsuitable for predicting the femoral head stability when the lag screw is placed in the inferior 1/3-central area. To follow-up the femoral head stability, vertical migration seems to be more practical.
延伸閱讀
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