Background

Osteoporotic intertrochanteric fractures often have postoperative complications despite a perfect reduction and an optimal fixation. We describe a simple technique using bone substitute augmentation and hypothesize that this method would prevent excessive sliding of the lag screw and potential subsequent complications.

Methods

Between January 2009 and July 2017, patients with osteoporotic intertrochanteric fractures who were treated with a dynamic hip screw (DHS) were enrolled in this retrospective cohort study. DHS group patients received conventional DHS treatment and BSA-DHS group patients received bone-substitute augmented DHS treatment. Factors such as demographics, Parker and Palmer mobility scores, health-related quality of life (HRQoL) scores (short-form Health Survey-12 Physical Component Summary [SF-12-PCS], and SF-12 Mental Component Summary [SF-12-MCS]), morbidities, mortality, and radiographic outcomes were compared.

Results

We enrolled 85 patients: DHS group = 37 and BSA-DHS group = 48. There was significant lag-screw sliding (mean: 9 mm and 3 mm, p < 0.001), varus collapse (mean: 7° and 3°, p < 0.001), and femoral shortening (mean: 10 mm and 3 mm, p < 0.001) in the DHS group compared to the BSA-DHS group. The ability to get around the house was significantly different between the DHS and BSA-DHS groups (p = 0.031) at 3 months. Postoperative scores were not significantly different after 6, 9 or 12 months, however. Scores for the ability to get out of the house and to go shopping and the SF-12-PCS were significantly worse in the DHS group at 3 and 6 months. Malunion and lag-screw cutout were also significantly worse in the DHS group (p = 0.037 and p = 0.033, respectively).

Conclusions

Bone-substitute augmentation appears effective to prevent typical postoperative complications experienced by the DHS group patients, and to improve functional outcomes. Additional prospective randomized large-scale cohort studies are necessary to confirm this conclusion.

Level of evidence

Therapeutic Level III.

中文翻译：

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骨替代强化治疗骨质疏松性转子间骨折的效果

背景

尽管完美复位和最佳固定，骨质疏松性粗隆间骨折经常出现术后并发症。我们描述了一种使用骨替代物增强的简单技术，并假设这种方法可以防止拉力螺钉过度滑动和潜在的后续并发症。

方法

在 2009 年 1 月至 2017 年 7 月期间，接受动态髋螺钉 (DHS) 治疗的骨质疏松性转子间骨折患者参加了这项回顾性队列研究。DHS 组患者接受常规 DHS 治疗，BSA-DHS 组患者接受骨替代增强 DHS 治疗。人口统计、Parker 和 Palmer 移动性评分、健康相关生活质量 (HRQoL) 评分等因素（简短的 Health Survey-12 物理成分总结 [SF-12-PCS] 和 SF-12 心理成分总结 [SF- 12-MCS]）、发病率、死亡率和影像学结果进行了比较。

结果

我们招募了 85 名患者：DHS 组 = 37 和 BSA-DHS 组 = 48。有显着的拉力螺钉滑动（平均：9 毫米和 3 毫米，p  < 0.001），内翻塌陷（平均：7° 和 3°，p < 0.001)，与 BSA-DHS 组相比，DHS 组的 股骨缩短（平均值：10 毫米和 3 毫米，p < 0.001）。在 3 个月时， DHS 组和 BSA-DHS 组之间的走动能力显着不同 ( p  = 0.031)。然而，术后评分在 6、9 或 12 个月后没有显着差异。在 3 个月和 6 个月时，DHS 组的出门购物能力和 SF-12-PCS 得分明显更差。DHS 组的畸形愈合和拉力螺钉切口也明显更差（p = 0.037 和p  = 0.033，分别）。

结论

骨替代物增强似乎可以有效预防 DHS 组患者经历的典型术后并发症，并改善功能结果。需要额外的前瞻性随机大规模队列研究来证实这一结论。

证据级别

治疗级别 III。