Henderson Christopher E, Lujan Trevor, Bottlang Michael, Fitzpatrick Daniel C, Madey Steve M, Marsh J Lawrence
Orthopaedics and Rehabilitation, University of Iowa Hospital and Clinics, Iowa City, IA 52242, USA.
Iowa Orthop J. 2010;30:61-8.
This study compared callus formation in distal femur fractures stabilized with locking plates and intramedullary nails to test the hypothesis that locking plates induce less fracture callus than IM nails.
Retrospective case matched study.
Two orthopaedic trauma centers.
174 distal femur fracture were reviewed to extract cases treated with retrograde IM nails (NAIL group, n = 12). These were then individually matched to cases treated with locking plates (Plate group, n = 12).
Retrograde IM nailing or locking plate fracture fixation.
Periosteal callus was measured on lateral and antero-posterior radiographs taken at 12 weeks after injury using validated software to objectively extract the size of peripheral callus from digital radiographs.
The NAIL group had 2.4 times more callus area per location (231 ± 304 mm(2)) than the PLATE group (95 ± 109 mm(2), p=0.028). Compared to the PLATE group, the NAIL group had 3.4 times more callus anteriorly (p=0.31), 2.6 times more callus posteriorly (p=0.25), and 2.3 times more callus medially (p=0.16). At 12 weeks after injury, no or minimal callus for secondary bone healing (<20 mm(2)) was present in 20% of callus locations in the NAIL group and in 54% of callus locations in the PLATE group.
Significantly less periosteal callus formed in fractures stabilized with locking plates than with IM nails. This result is likely multifactorial and further study of the interaction between construct stiffness and fracture healing in the distal femur is warranted.
本研究比较了使用锁定钢板和髓内钉固定的股骨远端骨折的骨痂形成情况，以验证锁定钢板诱导的骨折骨痂比髓内钉少的假设。
回顾性病例匹配研究。
两个骨科创伤中心。
对174例股骨远端骨折进行回顾，以提取接受逆行髓内钉治疗的病例（髓内钉组，n = 12）。然后将这些病例与接受锁定钢板治疗的病例（钢板组，n = 12）进行个体匹配。
逆行髓内钉固定或锁定钢板骨折固定。
使用经过验证的软件，在受伤后12周拍摄的正侧位X线片上测量骨膜骨痂，以客观地从数字X线片中提取外周骨痂的大小。
髓内钉组每个部位的骨痂面积（231±304 mm²）是钢板组（95±109 mm²，p = 0.028）的2.4倍。与钢板组相比，髓内钉组前方骨痂多3.4倍（p = 0.31），后方骨痂多2.6倍（p = 0.25），内侧骨痂多2.3倍（p = 0.16）。受伤后12周，髓内钉组20%的骨痂部位无或仅有少量用于二期骨愈合的骨痂（<20 mm²），而钢板组为54%。
与髓内钉相比，使用锁定钢板固定的骨折形成的骨膜骨痂明显更少。这一结果可能是多因素的，有必要进一步研究股骨远端结构刚度与骨折愈合之间的相互作用。
