小转子会影响粗隆间骨折术后功能恢复吗？

前言：

      粗隆间骨折常累及小转子，小转子累及与否是否会影响髋关节功能恢复？

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参考文献：van der Sijp MPL, Moonen L, Schipper IB, Krijnen P, du Pré KJ, Niggebrugge AHP. The functional effect of lesser trochanter involvement in hip fractures: A prospective cohort study. Injury. 2020 Nov;51(11):2634-2639.

在2020.11 Injury期刊上，来自荷兰的学者对老年髋部骨折患者，小转子是否累及对髋部功能恢复的影响作了研究。

Introduction

髋部骨折是年老体弱患者最常见的骨折。既往的研究表明，包括小转子分离的髋骨骨折患者术后髋关节屈曲强度受损。这些患者可能会经历长时间的功能障碍和更长的恢复时间，从而导致更长的康复旅程。 本研究旨在评估股骨转子间骨折中小转子分离对髋关节功能恢复的影响。

（Hip fractures are the most common fractures amongst frail older patients. Earlier studies have indicated an impaired hip flexion strength in patients with fractures that include detachment of the lesser trochanter. These patients may experience protracted functional impairment and longer recovery time, causing prolonged rehabilitation journeys. This study aimed to evaluate the effects of a detached lesser trochanter in trochanteric fractures on the recovery of hip function. ）

Methods

在2016年至2019年之间进行了一项前瞻性观察性队列研究。研究纳入了年龄在70岁及以上且AO 31A1-A3转子间骨折的社区居住患者。患者接受DHS或PFNA治疗，采用常规护理。分析了小转子累及与否的患者人群。主要结局指标是在术后6周，3个月和1年时用Harris Hip评分评估髋关节功能。次要指标包括Ludloff's试验，并发症，康复时间以及疼痛-独立性和生活质量得分。倾向性评分用于调整两组之间的任何基线差异。

（A prospective observational cohort study was performed between 2016 and 2019. Community dwelling patients aged 70 years or older with AO 31A1-A3 trochanteric fractures were included. Patients followed routine care and were treated with a DHS or PFNA. The groups with and without involvement of the lesser trochanter were analysed. The primary outcome was hip function assessed at 6 weeks, 3 months and 1 year after surgery with the Harris Hip Score. Secondary outcomes included the Ludloff’s test, complications, rehabilitation time, and pain-, independence-, and quality of life scores. A propensity score was used to adjust for any baseline differences between the two groups.）

Results

共纳入114例患者，其中51例（44.7％）累及小转子，63例（55.3％）未累及小转子。 在基线特征上观察到较小的差异。Harris髋关节评分未见显着差异（系数估计：3.31；95％CI，-5.09-11.72；P = 0.43）。在没有小转子累及的患者中，通过Ludloff试验，腰肌的屈曲功能通常更为正常（OR，2.33；95％CI，1.241–4.387；P = 0.009）。但其他次要结局均未见差异。

（A total of 114 patients were included, 51 (44.7%) with involvement of the lesser trochanter and 63 (55.3%) without. Minor differences were observed in the baseline characteristics. No significant difference was observed for the Harris Hip Score (coefficient estimate: 3.31; 95% CI, -5.09–11.72; P = 0.43). The flexion function of the iliopsoas muscle was more often normal with the Ludloff’s test in patients without involvement of the lesser trochanter (OR, 2.33; 95% CI, 1.241–4.387; P = 0.009). However, no differences were observed for any of the other secondary outcomes.）

表1：两组基线资料对比

表2：两组治疗结果对比

表3：两组Harris评分

表4：术后1年并发症

Conclusion

尽管在髋关节功能上没有发现差异，但更多伴小转子的粗隆间骨折患者表现出更长时间的髋关节屈曲受损。 然而，缺乏长期的、与临床相关的不利条件可证明将小转子固定是多余的。

（Although no differences in overall hip function were found, more hip fracture patients with involvement of the lesser trochanter showed prolonged impaired flexion of the hip. The absence of longterm, clinically relevant disadvantages however, proves fixing the lesser trochanter to be redundant.）

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