植入髓內鋼釘治療股骨近端骨折，葉片螺釘位置與股骨頭穿孔之關係研究

Studying The Correlation Between Tip-Apex Distance and Cleveland Zone for Preventing Screw Blade Perforation in Proximal Femoral Fracture Treatment

在老齡化社會中，低能量髖部挫傷引起年長骨質疏鬆民眾近端股骨骨折的發生率越來越高。髓內鋼釘的使用在治療這種骨折中漸趨普及。但是這些用於治療的植入物偶爾會發生葉片螺釘穿出的併發症；導致股骨頭穿孔、治療失效。過去文獻刊載關於螺絲尖端與股骨頭頂點距離（TAD）和克利夫蘭區域與葉片螺釘穿出之間的相關性知之甚少。在本研究中，回顧性分析了用PFNA II（近端股骨抗旋轉髓內固定鋼釘，Synthes，Solothurn，瑞士）治療的兩百五十六個近端股骨骨折病例。我們發現十例手術相關併發症（7.6％），十例患者中有六例發生葉片螺釘穿孔（4.6％）。在術後X光片分析中發現所有穿孔的病例的TAD小於20mm。我們藉由此研究結果，希望確立髓內鋼釘治療近端股骨骨折時，葉片螺釘適當的位置與長度。

 

Background and Purpose: Low-energy hip fractures are common in elderly women with osteoporosis. The trend of using intramedullary devices is increasing for treatment of extracapsular proximal femoral fractures. However, the blade screw cutout has been reported as the major complication of the intramedullary devices. In this study, we hypothesized the tip-apex distance and Cleveland zone within femoral head are related to blade screw cutout. Materials and Methods: A retrospective review was collected with 206 extracapsular proximal femoral fractures treated with PFNA II at Cathy General Hospital during November 2009 and September 2014. The charts were reviewed and the fractures were classified according to Orthopaedic Trauma Association (OTA) classification. Screw blade positions within the femoral head (tip-apex distance and Cleveland zone) were recorded from intraoperative and immediate postoperative radiographs to evaluate the short-term implant-related complication of screw blade cutout. Results: We selected a total of 131 patients with intertrochanteric and subtrochanteric fractures. This study observed 10 surgical-implant-related complications (7.6% out of total patients). Six cases of the screw blade cutout, perforation of the femoral head, had postoperative radiograph tip-apex distance (TAD) shorter than 20 mm, and four cases without cutout but were observed with implant migration. Conclusion: Fixation failure, ie the screw blade cutout, after proximal femoral nailing remains a major issue for surgeons. This study demonstrated the correlation between TAD and Cleveland zone for preventing screw blade perforation with the use of proximal femoral nail antirotation II (PFNA II; Synthes, Solothurn, Switzerland). With our discovery, we found that the TAD between the screw blade and the femoral head has a significant relationship (p<0.05) with the surgical complication cutout rate.