Abstract:Objective To explore the value of CT and X-ray in the classification and surgical methods of intertrochanteric fractures.Methods We retrospectively analysed the patients with intertrochanteric fracture who was treated at 3rd Hospital of Peking University and Yanqing Hospital before September 2016.Therewas a total of 261 cases with X-ray and CT examination retained.Six orthopaedic surgeons determined the AO classification and surgical methods according to X-ray and CT,respectively.Results CT examination did not show clear value of classification.For senior surgeons,they tended to change part of A2.1 to other subtypes after reading CT,with statistical differences (P<0.05).In terms of treatment methods,32 patients were changed to use extra-medullary plates due to the judgment of fracture of lateral trochanteric wallshown in CT.The differencewas statisticalsignificant (P<0.05).Meanwhile,CT reduced the differences in treatment methods among different surgeons.Conclusion Compared with X-ray,CT of great value in the diagnosis and treatment of intertrochanteric fractures,which is mainly reflected in the fact that senior surgeons are more accurate in the judgment of lateral wall fractures which requiring reconstruction,and select extra-medullary locking plate,which is more appropriate.
石雷 1,吕扬 2,周方 2*. CT与X线检查在股骨转子间骨折的诊断及治疗价值比较[J]. 实用骨科杂志, 2019, 25(4): 321-325.
Shi Lei 1,Lv Yang 2,Zhou Fang 2*. Comparison between CT and X-ray in the Diagnosis and Treatment of Intertrochanteric Fractures. sygkzz, 2019, 25(4): 321-325.
[1]Brauer CA,CocaPerraillon M,Cutler DM,et al.Incidence and mortality of hip fractures in the United States[J].JAMA,2009,302(14):1573-1579.
[2]张飞.成人股骨转子间骨折的临床特点及其变化:单中心3201例分析[D].石家庄:河北医科大学,2015.
[3]Mustonen AO,Koskinen SK,Kiuru MJ,et al.Acute knee trauma:analysis of multidetector computed tomography findings and comparison with conventional radiography[J].ActaRadiol,2005,46(8):866874.
[4]Haapamaki VV,Kiuru MJ,Koskinen SK,et al.Ankle and foot injuries:analysis of MDCT findings[J].AJR Am J Roentgenol,2004,183(3):615622.
[5]Mandell JC,Weaver MJ,Khurana B,et al.Computed tomography for occult fractures of the proximal femur,pelvis,and sacrum in clinical practice:single institution,dualsite experience[J].EmergRadiol,2018,25(3):265273.
[6]vanEmbden D,Rhemrev SJ,MeylaertsSA,et al.The comparison of two classfications for trochanteric femur fractures:the AO/ASIF classification and the Jensen classification[J].Injury,2010,41(4):377381.
[7]Cavaignaca E,Lecoq M,Ponsot A,et al.CT scan does not improve the reproducibility of trochanteric fracture classification:A prospective observational study of 53 cases[J].Orthop Trauma Surg Res,2013,99(1):4651.
[8]Pervez H,Parker MJ,Pryor GA,et al.Classification of trochanteric fracture of the proximal femur:a study of the reliability of current systems[J].Injury,2002,33(8):713715.
[9]van Embden D,Scheurkogel MM,Schipper IB,et al.The value of CT compared to radiographs in the classification and treatment plan of trochanteric fractures[J].Arch Orthop Trauma Surg,2016,136(8):10911097.
[10]Platzer P,Thalhammer G,Wozasek GE,et al.Femoral shortening after surgical treatment of trochanteric fractures in nongeriatricpatients[J].J Trauma,2008,64(4):982989.
[11]Zehir S,Zehir R,Azboy I,et al.Proximal femoral nail antirotation against dynamic hip screw for unstable trochanteric fractures:a prospective randomized comparison[J].Eur J Trauma Emerg Surg,2015,41(4):393400.
[12]Ma KL,Wang X,Luan FJ,et al.Proximal femoral nails antirotation,Gamma nails,and dynamic hip screws for fixation of intertrochanteric fractures of femur:A metaanalysis[J].OrthopTrauma Surg Res,2014,100(8):859866.
[13]Seyhan M,Turkmen I,UnayK,et al.Do PFNA devices and Intertan nails both have the same effects in the treatment of trochanteric fractures? A prospective clinical study[J].J Orthop Sci,2015,20(6):10531061.
[14]Yu W,Zhang X,Zhu X,et al.A retrospective analysis of the InterTan nail and proximal femoral nail antirotationAsia in the treatment of unstable intertrochanteric femur fractures in the elderly[J].J Orthop Surg Res,2016(1):1110.
[15]Huang Y,Zhang C,Luo Y.A comparative biomechanical study of proximal femoral nail (InterTAN) and proximal femoral nail antirotation for intertrochanteric fractures[J].Int Orthop,2013,37(12):24652473.
[16]Parker M,Handoll H.Gamma and other cephalocondylic intramedullarynails versus extramedullary implants for extracapsular hip fractures in adults[J].Cochrane Database Syst Rev,2010,8(9):CD00009
[17]Singh AK,Narsaria N,Gupta RK,et al.A biomechanical study comparing proximal femur nail and proximal femur locking compression plate in fixation of reverse oblique proximal femur fractures[J].Injury,2017,48(10):20502053.
[18]Ma JX,Wang J,Xu WG,et al.Biomechanical outcome of proximal femoral nail antirotation is superior to proximal femoral locking compression plate for reverse oblique intertrochanteric fractures:a biomechanical study of intertrochanteric fractures[J].Acta Orthop Trauma Turc,2015,49(4):426432.
[19]Socci AR,Casemyr NE,Leslie MP,et al.Implant options for the treatment of intertrochanteric fractures of the hip:rationale,evidence,and recommendations[J].Bone Joint J,2017,99 (1):128133.
[20]Gotfried Y.The lateral trochanteric wall:a key element in the reconstruction of unstable pertrochanteric hip fractures[J].Clin Orthop Relat Res,2004 (425):8286.
[21]Palm H,Jacobsen S,SonneHolm S,et al.Integrity of the lateral femoral wall in intertrochanteric hipfractures:an important predictor of a reoperation[J].J Bone Joint Surg (Am),2007,89(3):470475.
[22]Wei J,Qin DA,Guo XS.Curative effect analysis on proximal frmoral nail antirotation for the treatment of femoral intertrochanteric fracture and integrity of lateral trochanteric wall[J].Zhongguo Gushang,2015,28(6):572575.
[23]Bong MR,Patel V,Iesaka K,et al.Comparison of a sliding hip screw with a trochanteric lateral support plate to an intramedullary hip screw for fixation of unstable intertrochanteric hip fractures:a cadaver study[J].J Trauma,2004,56(4):791794.
[24]Gupta RK,Sangwan K,Kamboj P,et al.Unstable trochanteric fractures:the role of lateralwallreconstruction[J].IntOrthop,2010,34(1):125129.