■对于使用三套空心螺钉(TCS)治疗的年轻股骨颈骨折,治疗失败仍然是一个挑战。这项研究旨在确定可以预测治疗失败的新放射学参数,并提出手术技术以提高TCS的成功率或帮助选择替代方法。
■我们对2014年2月至2022年6月期间接受股骨颈骨折手术的87例符合纳入标准的患者进行了回顾性分析。实现结合的患者被归类为非失败(第1组),而那些经历骨不连的人被归类为失败(第2组)。评估了各种人口统计学和临床因素,包括年龄,性别,骨折侧,和骨折分类(花园和Pauwels)。放射学参数,如内侧皮质的碎片,calcar区的术后骨折移位,颈骨干角(CDA)差异(内翻/外翻对齐),和几个新定义的参数(修改的尖端顶点距离(m-TAD),尖端皮质距离(TCD),上下螺钉-皮质距离/颈部直径,Calcar螺钉-皮层距离/颈部直径(Buyukdogan指数),评估亚资本区/基底子宫颈区(Dogan指数)。研究了发生骨不连的患者,以根据放射学参数确定潜在的临界值。
■患者,61人被归类为非失败(第1组),26人被归类为失败(第2组)。两组在性别方面表现出相似的分布,骨折侧,Pauwels分类,和随访次数(p>0.05)。然而,第2组的平均年龄高于第1组(p=0.006)。在花园分类方面,两组之间存在显着差异(p=0.0003)。此外,术后calcar移位,内翻对齐,m-TAD,中药,上下螺钉-皮层距离/颈部直径比,Buyukdogan指数,和Dogan指数在各组间有显著性差异(p<0.05)。相反,内侧call碎裂在两组间无显著差异(p>0.05).
■Dogan指数(≤0.5)可以作为治疗失败的独立术前预测因子,帮助选择比TCS更有效的手术干预措施。Varus对齐(>10度),上-下螺钉-皮质距离颈部直径(>0.45)和Buyukdogan指数(>0.2)受TCS应用的手术技术影响,应考虑降低TCS的成功率.
UNASSIGNED: Treatment failure remains a challenge in young femoral neck fractures treated with triple cannulated screws (TCS). This study aims to identify novel radiological parameters that can predict treatment failure and propose surgical techniques to enhance the success of TCS or aid in selecting alternative methods.
UNASSIGNED: We conducted a retrospective analysis of 87 patients who underwent surgery for femoral neck fractures between February 2014 and June 2022, meeting the inclusion criteria. Patients achieving union were categorized as Non-Fail (Group 1), while those experiencing
nonunion were categorized as Fail (Group 2). Various demographic and clinical factors were assessed, including age, gender, fracture side, and fracture classification (Garden and Pauwels). Radiological parameters such as fragmentation in the medial cortex, postoperative fracture displacement in the calcar region, collo-diaphyseal angle (CDA) difference (varus/valgus alignment), and several newly defined parameters (modified tip apex distance (m-TAD), tip cortex distance (TCD), upper-lower screw-cortex distance/neck diameter, the calcar screw-cortex distance/neck diameter (Buyukdogan index), and sub-capital area/basocervical area (Dogan index) were evaluated. Patients developing
nonunion were studied to establish potential cut-off values based on radiological parameters.
UNASSIGNED: Of the patients, 61 were classified as Non-Fail (Group 1) and 26 as Fail (Group 2). Both groups exhibited similar distributions in terms of gender, fracture side, Pauwels classification, and follow-up times (p > 0.05). However, Group 2 had a higher mean age than Group 1 (p = 0.006). There was a significant difference between the two groups in terms of Garden classification (p = 0.0003). Furthermore, postoperative calcar displacement, varus alignment, m-TAD, TCD, upper-lower screw-cortex distance/neck diameter ratio, Buyukdogan index, and Dogan index showed significant differences between the groups (p < 0.05). Conversely, medial calcar fragmentation did not differ significantly between the groups (p > 0.05).
UNASSIGNED: The Dogan index (≤ 0.5) can serve as an independent preoperative predictor of treatment failure, aiding in the selection of more effective surgical interventions than TCS. Varus alignment (> 10 degrees), the upper-lower screw-cortex distance to the neck diameter (> 0.45) and Buyukdogan index (> 0.2) are influenced by the surgical technique of TCS application and should be considered to decrease the success of TCS.