PDF(Pubmed)
Abstract：
Proximal femur fractures in the elderly are associated with significant loss of independence, mobility, and quality of life. This prospective study aimed to: (1) investigate gait biomechanics in intertrochanteric fracture (ITF) patients (A1 and A2 AO/OTA) managed via femoral nailing at 6 weeks and 6 months postoperative and how these compared with similarly aged elderly controls; and (2) investigate whether femoral offset shortening (FOS) and lateral lag screw protrusion (LSP) were associated with changes in gait biomechanics at postoperative time points. Hip radiographs and gait data were collected for 34 patients at 6 weeks and 6 months postoperatively. Gait data were also collected from similarly aged controls. FOS and LSP were measured from radiographs. Joint angles, external moments, and powers were calculated for the hip, knee, and ankle and compared between time points in ITF patients and healthy controls using statistical parametric mapping. The relationship between radiographic measures with gait speed, step length, peak hip abduction, and maximum hip abduction moment was assessed using a Pearson correlation. External hip adduction moments and hip power generation improved in the first 6 months postoperative, but differed significantly from healthy controls during single limb stance. LSP showed a moderate correlation with maximum hip abduction moment at 6 weeks postoperative (r = -0.469, p = 0.048). These results provide new detail on functional outcomes after ITF and potential mechanisms that functional deficiencies may stem from. Lag screw prominence may be an important factor in maintaining functional independence and minimizing the risk of secondary falls after ITF in the elderly.
摘要：
老年人股骨近端骨折与独立性的显著丧失有关，移动性,和生活质量。这项前瞻性研究旨在：（1）研究术后6周和6个月通过股骨钉进行股骨粗隆间骨折（ITF）患者（A1和A2AO/OTA）的步态生物力学，以及与类似年龄的老年人对照组的比较；（2）研究术后时间点股骨偏移缩短（FOS）和外侧拉力螺钉突出（LSP）是否与步态生物力学变化有关。收集34例患者术后6周和6个月的髋部X光片和步态数据。也从类似年龄的对照收集步态数据。从X射线照片测量FOS和LSP。关节角度,外部时刻，计算了髋关节的功率，膝盖,和踝关节，并使用统计参数映射在ITF患者和健康对照组的时间点之间进行比较。射线照相测量与步态速度之间的关系，步长,髋关节外展高峰,最大髋关节外展力矩使用Pearson相关性进行评估。术后前6个月外髋内收力矩和髋功率改善，但在单肢站立时与健康对照组显着不同。LSP与术后6周最大髋关节外展力矩呈中度相关（r=-0.469，p=0.048）。这些结果提供了ITF后功能结果的新细节以及功能缺陷可能源于的潜在机制。滞后螺钉突出可能是维持功能独立性和最大程度降低老年ITF后继发性跌倒风险的重要因素。
