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Title: [Comparison of the predictive value of tip-apex distance and calcar referenced tip-apex distance in treatment of femoral intertrochanteric fractures with Asian type proximal femoral nail fixation].
Author: Cai Y, Feng J, Chen Y, Shi M, Yu Z, Fang L, Zhou L, Xu S.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2020 Nov 15; 34(11):1359-1363. PubMed ID: 33191690.
Abstract:
OBJECTIVE: To compare the predictive value of the two concepts for complications by comparing the incidences of surgical complications associated with different tip-apex distance (TAD) and calcar referenced tip-apex distance (Cal-TAD) in the treatment of femoral intertrochanteric fractures with Asian type proximal femoral nail (APFN) fixation. METHODS: A total of 188 cases of femoral intertrochanteric fractures treated with APFN fixation between January 2014 and December 2018 were collected according to inclusion criteria. TAD and Cal-TAD were measured on the X-ray film at immediate after operation; the patients were divided into two groups according to the measurement results: <25 mm and ≥25 mm. Gender, age, and fracture side and AO type were recorded. The patients in each group were reviewed whether there was delayed fracture union or nonunion, whether the screw blade moved axially, whether the femoral neck collapsed or even screw blade cut out, whether the internal fixator became loose or broken within 12 months after operation. Then statistical analysis was performed. RESULTS: There were 119 patients with TAD<25 mm and 69 patients with TAD≥25 mm, and 142 patients with Cal-TAD<25 mm and 46 patients with Cal-TAD≥25 mm. There was no significant difference in gender, age, or fracture side and AO type between groups ( P>0.05). During the follow-up, 6 patients (5.04%) with TAD<25 mm, 10 patients (14.49%) with TAD≥25 mm had complications, and 1 patient (0.70%) with Cal-TAD<25 mm and 15 patients (32.61%) with Cal-TAD≥25 mm had complications. There were significant differences in the incidence of complication between the patients with different TAD, between the patients with different Cal-TAD, and between patients with TAD<25 mm and Cal-TAD<25 mm ( P<0.05). CONCLUSION: In the operation of femoral intertrochanteric fracture with APFN fixation, surgical complications can be significantly reduced when TAD or Cal-TAD was controlled within 25 mm, Cal-TAD is more significant in the prediction of postoperative complications. 目的: 通过比较亚洲型股骨近端髓内钉（Asian type proximal femoral nail，APFN）治疗股骨转子间骨折时，不同尖顶距（tip-apex distance，TAD）和股距尖顶距（calcar referenced tip-apex distance，Cal-TAD）患者间手术并发症发生情况，探讨上述两种概念对股骨转子间骨折术后并发症的预测价值。. 方法: 以 2014 年 1 月—2018 年 12 月采用 APFN 治疗且符合选择标准的 188 例股骨转子间骨折患者作为研究对象，于术后即刻 X 线片测量 TAD 和 Cal-TAD，并根据测量结果将其分别分为<25 mm 及≥25 mm 两组。记录患者性别、年龄、骨折侧别及 AO 分型；患者术后 12 个月内并发症发生情况，包括骨折延迟愈合或不愈合、螺旋刀片轴向移动、股骨颈内翻塌陷或螺旋刀片向上切出、内固定物松动或断裂；然后进行统计分析。. 结果: 188 例患者中 TAD<25 mm 119 例、≥25 mm 69 例，Cal-TAD<25 mm 142 例、≥25 mm 46 例。TAD<25 mm、≥25 mm 组间以及 Cal-TAD<25 mm、≥25 mm 组间患者性别、年龄、骨折侧别及 AO 分型差异均无统计学意义（ P>0.05）。随访期间，TAD<25 mm 组 6 例（5.04%）、≥25 mm 组 10 例（14.49%）发生并发症，Cal-TAD<25 mm 组 1 例（0.70%）、≥25 mm 组 15 例（32.61%）发生并发症；不同 TAD 患者间、不同 Cal-TAD 患者间，以及 TAD<25 mm 与 Cal-TAD<25 mm 患者间并发症发生率比较，差异均有统计学意义（ P<0.05）。. 结论: APFN 内固定治疗股骨转子间骨折术中，TAD 或 Cal-TAD 控制在25 mm 以内均可明显减少手术并发症，Cal-TAD 对于术后并发症的预测价值更大。.

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