PDF(Pubmed)
Abstract：
UNASSIGNED: This study aimed to demonstrate the feasibility of lag screw exchange for painful lateral soft tissue impingement in patients initially treated with cephalomedullary nailing (CMN) for an intertrochanteric hip fracture.
UNASSIGNED: Ten patients initially treated with CMN for unstable intertrochanteric fractures presenting with persistent pain and radiographic evidence of lag screw lateral migration were treated with exchange of original screw with shorter lag screw buried in the lateral cortex to prevent impingement. Patients were evaluated for resolution of pain and achievement of pre-fracture ambulatory status at 6 months post-operatively.
UNASSIGNED: Average age was 71.5 years (range: 62-88). Average length of follow-up was 24.9 months. All patients were female, with an average Charlson Comorbidity Index of 1.0 (0-3) and average Body Mass Index of 22.2 (16.0-31.1). Five of ten patients (50.0%) were treated with a cortisone injection in the trochanteric bursa prior to screw exchange with temporary pain relief. Five (50.0%) patients presented with limited range of hip motion. Five (50.0%) had history of prior or current bisphosphonate use. Average lag screw prominence was noted to be 12.2mm (7.9-17.6mm) on radiographic evaluation. Screw exchange was performed at an average of 18.6 months (5.4-44.9 months) following the index procedure. Average operating time of the screw exchange procedure was 45.3 minutes (34-69 minutes) and blood loss was <50mL in all cases. Replacement lag screws were an average of 16.0mm (10-25mm) shorter than the initial screw. All patients achieved complete or significant resolution of lateral thigh pain, and nine (90%) returned to pre-fracture ambulatory status by eight weeks after screw exchange. All patients remained pain free at six months after screw exchange.
UNASSIGNED: Lag screw exchange is a efficacious method to address the mechanical irritation of laterally protruding lag screws following IT hip fracture, while also prophylaxing against subsequent femoral neck fractures. Level of Evidence: IV.
UNASSIGNED: Ten patients initially treated with CMN for unstable intertrochanteric fractures presenting with persistent pain and radiographic evidence of lag screw lateral migration were treated with exchange of original screw with shorter lag screw buried in the lateral cortex to prevent impingement. Patients were evaluated for resolution of pain and achievement of pre-fracture ambulatory status at 6 months post-operatively.
UNASSIGNED: Average age was 71.5 years (range: 62-88). Average length of follow-up was 24.9 months. All patients were female, with an average Charlson Comorbidity Index of 1.0 (0-3) and average Body Mass Index of 22.2 (16.0-31.1). Five of ten patients (50.0%) were treated with a cortisone injection in the trochanteric bursa prior to screw exchange with temporary pain relief. Five (50.0%) patients presented with limited range of hip motion. Five (50.0%) had history of prior or current bisphosphonate use. Average lag screw prominence was noted to be 12.2mm (7.9-17.6mm) on radiographic evaluation. Screw exchange was performed at an average of 18.6 months (5.4-44.9 months) following the index procedure. Average operating time of the screw exchange procedure was 45.3 minutes (34-69 minutes) and blood loss was <50mL in all cases. Replacement lag screws were an average of 16.0mm (10-25mm) shorter than the initial screw. All patients achieved complete or significant resolution of lateral thigh pain, and nine (90%) returned to pre-fracture ambulatory status by eight weeks after screw exchange. All patients remained pain free at six months after screw exchange.
UNASSIGNED: Lag screw exchange is a efficacious method to address the mechanical irritation of laterally protruding lag screws following IT hip fracture, while also prophylaxing against subsequent femoral neck fractures. Level of Evidence: IV.
摘要：
■这项研究旨在证明在最初接受头髓内钉（CMN）治疗股骨粗隆间髋部骨折的患者中，方头螺钉置换用于疼痛性外侧软组织撞击的可行性。
■10例最初接受CMN治疗的不稳定型股骨粗隆间骨折患者，表现为持续性疼痛和影像学证据显示方头螺钉侧向移动，用埋在外侧皮质的较短方头螺钉交换原始螺钉以防止撞击。术后6个月对患者的疼痛缓解和骨折前行走状态的实现进行评估。
■平均年龄为71.5岁（范围：62-88）。平均随访时间为24.9个月。所有患者均为女性,平均Charlson合并症指数为1.0（0-3），平均体重指数为22.2（16.0-31.1）。10例患者中有5例（50.0％）在股骨转子囊内注射可的松，然后进行螺钉交换并暂时缓解疼痛。五名（50.0％）患者的髋关节活动范围有限。5人（50.0％）有先前或当前使用双膦酸盐的历史。射线照相评估时，平均方头螺钉突出度为12.2mm（7.9-17.6mm）。在索引程序之后,在平均18.6个月(5.4-44.9个月)进行螺杆交换。在所有情况下，螺钉交换程序的平均操作时间为45.3分钟（34-69分钟），失血量<50mL。替换方头螺钉平均比初始螺钉短16.0mm（10-25mm）。所有患者大腿外侧疼痛完全或显著消退，9人(90%)在更换螺钉8周后恢复骨折前的卧床状态.所有患者在螺钉更换后六个月保持无痛。
■延迟螺钉交换是一种有效的方法，可以解决IT髋部骨折后侧向突出的延迟螺钉的机械刺激，同时还可以预防随后的股骨颈骨折。证据等级：IV。
■10例最初接受CMN治疗的不稳定型股骨粗隆间骨折患者，表现为持续性疼痛和影像学证据显示方头螺钉侧向移动，用埋在外侧皮质的较短方头螺钉交换原始螺钉以防止撞击。术后6个月对患者的疼痛缓解和骨折前行走状态的实现进行评估。
■平均年龄为71.5岁（范围：62-88）。平均随访时间为24.9个月。所有患者均为女性,平均Charlson合并症指数为1.0（0-3），平均体重指数为22.2（16.0-31.1）。10例患者中有5例（50.0％）在股骨转子囊内注射可的松，然后进行螺钉交换并暂时缓解疼痛。五名（50.0％）患者的髋关节活动范围有限。5人（50.0％）有先前或当前使用双膦酸盐的历史。射线照相评估时，平均方头螺钉突出度为12.2mm（7.9-17.6mm）。在索引程序之后,在平均18.6个月(5.4-44.9个月)进行螺杆交换。在所有情况下，螺钉交换程序的平均操作时间为45.3分钟（34-69分钟），失血量<50mL。替换方头螺钉平均比初始螺钉短16.0mm（10-25mm）。所有患者大腿外侧疼痛完全或显著消退，9人(90%)在更换螺钉8周后恢复骨折前的卧床状态.所有患者在螺钉更换后六个月保持无痛。
■延迟螺钉交换是一种有效的方法，可以解决IT髋部骨折后侧向突出的延迟螺钉的机械刺激，同时还可以预防随后的股骨颈骨折。证据等级：IV。
