Background and Objectives: This study aimed to compare the biomechanical properties and outcomes of osteoporotic intertrochanteric fractures treated with two different helical blade systems, the trochanteric fixation nail-advanced (TFNA) and proximal femoral nail antirotation II (PFNA), to evaluate the efficacy and safety of the newly introduced TFNA system. Materials and Methods: A biomechanical comparison of the two helical blades was performed using uniaxial compression tests on polyurethane foam blocks of different densities. The peak resistance (PR) and accumulated resistance (AR) were measured during the 20 mm advancement through the test block. For clinical comparison, 63 osteoporotic intertrochanteric fractures treated with TFNA were identified and compared with the same number of fractures treated with PFNA using propensity score matching. Ambulatory status, medial migration, lateral sliding, fixation failure, and patient-reported outcomes were compared between the two groups over a minimum of 1 year's follow up. Results: The uniaxial compression test showed that a slightly, but significantly lower resistance was required to advance the TFNA through the test block compared with the PFNA (20 PCF, p = 0.017 and p = 0.026; 30 PCF, p = 0.007 and p = 0.001 for PR and AR, respectively). Clinically, the two groups showed no significant differences in post-operative ambulatory status and patient-reported outcomes. However, in TFNA groups, significantly more medial migration (TFNA, 0.75 mm; PFNA, 0.40 mm; p = 0.0028) and also, lateral sliding was noted (TFNA, 3.99 mm; PFNA, 1.80 mm; p = 0.004). Surgical failure occurred in four and two fractures treated with the TFNA and PFNA, respectively. Conclusions: The results of our study suggest that the newly introduced TFNA provides clinical outcomes comparable with those of the PFNA. However, inferior resistance to medial migration in the TFNA raises concerns regarding potential fixation failures.

中文翻译：

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使用生物力学分析和临床评估比较用于治疗骨质疏松转子间骨折的螺旋刀片系统。

背景和目的：本研究旨在比较两种不同的螺旋刀片系统，转子固定钉高级（TFNA）和股骨近端抗旋转 II（PFNA）治疗骨质疏松性转子间骨折的生物力学特性和结果，以评估疗效和新推出的 TFNA 系统的安全性。材料和方法：通过对不同密度的聚氨酯泡沫块进行单轴压缩试验，对两种螺旋叶片进行了生物力学比较。峰值电阻 (PR) 和累积电阻 (AR) 在通过测试块前进 20 毫米的过程中测量。为了进行临床比较，确定了 63 例接受 TFNA 治疗的骨质疏松性转子间骨折，并使用倾向评分匹配与使用 PFNA 治疗的相同数量的骨折进行了比较。在至少 1 年的随访中比较两组的行走状态、内侧迁移、侧向滑动、固定失败和患者报告的结果。结果：单轴压缩试验表明，与 PFNA 相比，TFNA 推进通过试验块所需的阻力略有但显着降低（20 PCF，p = 0.017 和 p = 0.026；30 PCF，p = 0.007 和 p = PR 和 AR 分别为 0.001）。临床上，两组在术后门诊状态和患者报告的结果方面没有显着差异。然而，在 TFNA 组中，显着更多的内侧迁移（TFNA，0.75 毫米；PFNA，0.40 毫米；p = 0.0028）以及横向滑动（TFNA，3.99 毫米；PFNA，1.80 毫米；p = 0.004）。使用 TFNA 和 PFNA 治疗的骨折有 4 例和 2 例发生手术失败，分别。结论：我们的研究结果表明，新引入的 TFNA 提供的临床结果与 PFNA 相当。然而，TFNA 对内侧迁移的抵抗力较差，这引起了对潜在固定失败的担忧。