| Objective:Combined with the new concept of Calcar-referenced Tip-apex Distance(Cal-TAD)which put forward by foreign in recent years,the foctors of blade cutting after PFNA of intertrochanteric fracture were analyzed.Aim to reducing the incidence of cutting with helical blades and providing reference for clinical treatment of intertrochanteric fracture with PFNA.Methods:Patients with intertrochanteric fractures treated with PFNA internal fixation from January 1st 2011 to August 1st 2017 in the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine were selected.Cases that meet the inclusion criteria are divided into cutting and non-cutting groups according to whether or not the screw blade is cut significantly 3 months after the operation.The age,sex,preoperative and postoperative imaging data of the two groups were collected.The classification of Jensen-Evans fracture,the stability of fracture type,the type of lateral wall and the Singh index of bone mass were judged by X-ray examination before operation.The quality of fracture reduction,the angle of neck after reduction,the supporting state of medial cortex,tip-apex distance(TAD),calcar-referenced tip-apex distance,the position of the blade in femoral head in AP and LAT X-ray,the locking state of the distal screw were collected according to the X-ray examination within 1 week after operation.Comparison of baseline data between two groups.Using univariate logistic regression analysis to screen of risk factors.And multivariate logistic regression analysis were used to confirm the independent risk factors.Results:The age of the cutting group was 81.70±6.08 years old,6 males and 4females.There were 1 case of stable fracture,9 cases of unstable type.In Jensen-Evans type,1 case of type Ⅱ,3 cases of type Ⅲ,5 cases of type Ⅴ,1 case of reverse trochanter type,0 case of type Ⅰ.In lateral wall type,1 case of type Ⅰ,8 cases of type Ⅱ and 1 case of type Ⅲ.In Singh index,1 case of Ⅱ,3 cases of Ⅲ,4 cases of Ⅳ,2 cases of Ⅴ,0 cases ofⅠandⅥ.In the quality of reduction,4 cases of good,4 cases of acceptable,1case of poor.5 cases of cervical angle ≥ 130 °,5 cases of < 130 °.In medial cortex support after reduction,1 case of positive support,7 cases of neutral support and 2 cases of negative support.The position of the blade in femoral head in AP Xray,4 cases in superior,5 cases in central and 1 case in inferior.The position of the blade in femoral head in LAT Xray,1 case in anterior,6 cases in central and 3 cases in posterior.The tip-apex distance was 23.24 ±5.50 mm and the calcar-referenced tip-apex distance was 34.22 ±6.82 mm.The distal screw state,2 cases were motorization and 8 cases were static.The age of the non-cutting group was 81.22±8.50 years old,21 males and 51 females.There were 18 case of stable fracture,54 cases of unstable type.In Jensen-Evans type,4 cases of type Ⅰ,14 case of type Ⅱ,16 cases of type Ⅲ,21 cases of type Ⅳ,16 cases of type Ⅴ,1 case of reverse trochanter type.In lateral wall type,18 case of type Ⅰ,53 cases of typeⅡ and 1 case of type Ⅲ.In Singh index,13 case of Ⅱ,33 cases of Ⅲ,13 cases of Ⅳ,11 cases of Ⅴ,2 cases of Ⅵ and 0 cases ofⅠ.In the quality of reduction,41 cases of good,27 cases of acceptable,4 case of poor.60 cases of cervical angle ≥ 130 °,12 cases of < 130 °.In medial cortex support after reduction,36 case of positive support,27 cases of neutral support and 9 cases of negative support.The position of the blade in femoral head in AP Xray,6 cases in superior,38 cases in central and 28 case in inferior.The position of the blade in femoral head in LAT Xray,6 case in anterior,59 cases in central and 7 cases in posterior.The tip-apex distance was23.24±5.50 mm and the calcar-referenced tip-apex distance was 23.68±6.32 mm.The distal screw state,24 cases were motorization and 48 cases were static.Intergroup contrast,age,sex,fracture type,Jensen-Evans type,lateral wall type,Singh index,reduction quality,distal screw status have no statistical difference(P>0.05).In univariate logistic analysis,male,lateral wall typeⅢ,neck shaft angle less than 130 °after reduction,blade position in superior on AP radiograph and in posterior on LAT radiograph,TAD and Cal-TADare all risk factors of screw cutting(OR>1,p<0.1).And positive support is a protective factor relative to neutral support(OR>1,p<0.1).The multivariate logistic regression analysis of the above risk factors showed that Cal-TAD is an independent risk factor(OR=5.138,p=0.039,p<0.05).Conclusion:Cal-TAD value is an independent risk factor for predicting blade cutting after PFNA in elderly patients with intertrochanteric fracture.In the treatment of intertrochanteric fractures with PFNA,the application of the Cal-TAD concept can make the blade in inferior position to reduce the cutting rate of the screw blade. |
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