粗隆间骨折好发于老龄患者，为三大骨质疏松性骨折之一，通常需采用内固定治疗。粗隆间骨折内固定的选择，与骨折类型密切相关。关于小转子及内侧壁的重要性，已经越来越受到重视，部分内固定的失效也与其相关。有学者研究了粗隆间骨折累及小转子及内侧壁的大小与内固定失效的关系，结果发表在Injury期刊上。

Introduction（介绍）

介绍股骨粗隆间骨折内侧壁骨块的分类，并探讨固定后植入失败的潜在术前预测因素。

[Introduction: To introduce a classification for medial wall fragments in pertrochanteric femur fratures and investigate potential preoperative predictors of implant failure following fixation.]

Material and Methods（病例与方法）

回顾性分析自2008年8月至2018年5月间接受髓内固定物常规手术治疗的股骨粗隆间骨折伴内侧壁骨折的324例患者的病历资料。注意到潜在的预测因素，包括年龄、性别、体重指数、合并症、骨折的AO/OTA分类。

内侧壁骨折分为三种类型:

I型：小转子撕脱骨折；骨折线不超过小转子基底部；

II型：小转子基底部附近累及后内侧皮质；骨折线未达到后壁中线；

III型：累及后内侧皮质；骨折线达到或超过后壁中线。

图1 病跟依据小转子骨折累及的后内侧皮质范围，将其分为三型。例挑选与治疗方法流程图。

表1 各内固定方式病例数量及失效率。

[Patients and Methods:Medical records of 324 adult patients receiving routine operative treatment using intramedullary devices for pertrochanteric femur fractures with medial wall fragments between August 2008 and May 2018 were retrospectively analyzed. Potential predictors including age, gender, body mass index, comorbidities, AO/OTA classification of fractures were noted. The medial wall fractures were categorized into three types: 1) Type I: avulsion of the lesser trochanter; fracture line does not exceed the base of the lesser trochanter; 2) Type II: fragment involving the posterior cortex near the base of the lesser trochanter; fracture line does not reach the midline of the posterior wall; 3) Type III: fragment involving the large posterior cortex; fracture line reaches or exceeds the midline of the posterior wall.]

Results（结果）

8例(2.5%)内固定失效包括1/186的I型骨折、1/76的II型骨折和6/62的III型骨折。每种骨折类型的失效率在I型中为0.5%，在II型中为1.3%，在III型中显著增加到9.7%(优势比[OR]，19.821；95%置信区间[CI]，2.337-168.135；p=0.001。

[Results: The 8 (2.5%) implant failures comprised 1 in 186 Type I fractures, 1 in 76 Type II fractures and 6 in 62 Type III fractures. The failure rates of each fracture type were 0.5% in Type I, 1.3% in Type II and significantly increased to 9.7% in Type III (odds ratio [OR], 19.821; 95% confidence interval [CI], 2.337-168.135; p=0.001.]

表2 内固定失效病例的基本资料。

表3  不同类型骨折的内固定失效率。

图2  84岁患者，III型骨折，伴有内侧壁骨块，未复位，术后1月复查良好（c）,术后3月复查螺钉切出（d）。

Conclusion（结论）

III型骨折的内固定失败率显著增加。对于骨科医生来说，术前识别III型骨折是很重要的，在使用髓内钉进行手术时，应考虑内侧壁骨块的复位和固定。[Conclusion:Type III fractures had a significantly increased failure rate. It is important for orthopedists to identify Type III fractures presurgically, reduction of the medial wall fragment and fixation should be considered during surgery using intramedullary nails.]