Nayak Ravi M, Koichade M R, Umre Alok N, Ingle Milind V
Lilavati Hospital and Research Centre, Mumbai, India.
J Orthop Surg (Hong Kong). 2011 Aug;19(2):185-90. doi: 10.1177/230949901101900211.
To evaluate treatment outcomes of minimally invasive plate osteosynthesis (MIPO) for distal femoral fractures in 31 patients.
22 male and 9 female consecutive patients aged 21 to 65 (mean, 42) years underwent minimally invasive plate osteosynthesis using a locking compression plate (LCP) for distal femoral fractures. The causes of injury were vehicular accidents (n=24), falls (n=6), and assault (n=1). According to the AO classification, the fractures were classified as types A1 (n=10), A2 (n=7), and A3 (n=14). Most fractures were closed; 3 were Gustilo type-II fractures. Clinical and functional outcomes were assessed using the Knee Society Scores.
The mean operating time was 70 (range, 60-100) minutes. The mean length of hospital stay was 9 (6-14) days. The mean time to union was 3.7 (range, 2.8-4.6) months. The mean follow-up period was 18 (14-26) months. At the one-year follow-up, 29 of the patients had good or excellent outcomes. No patient had angular or rotational deformity of >10º. One osteoporotic woman with a type-A1 fracture had implant failure at 10 weeks and underwent revision surgery. Another patient with a type-A1 fracture had persistent pain on the lateral aspect of the distal thigh and underwent implant removal at 22 months. No patient developed deep infection, malunion or nonunion.
MIPO using a LCP achieves favourable biological fixation for distal femoral fractures with few complications. Bone grafting is not needed even in cases of metaphyseal comminution. Proper patient selection and preoperative planning are essential to prevent complications.
评估31例股骨远端骨折患者采用微创钢板接骨术（MIPO）的治疗效果。
22例男性和9例女性连续患者，年龄21至65岁（平均42岁），采用锁定加压钢板（LCP）对股骨远端骨折进行微创钢板接骨术。受伤原因包括交通事故（n = 24）、跌倒（n = 6）和袭击（n = 1）。根据AO分类，骨折分为A1型（n = 10）、A2型（n = 7）和A3型（n = 14）。大多数骨折为闭合性骨折；3例为Gustilo II型骨折。使用膝关节协会评分评估临床和功能结果。
平均手术时间为70（范围60 - 100）分钟。平均住院时间为9（6 - 14）天。平均愈合时间为3.7（范围2.8 - 4.6）个月。平均随访期为18（14 - 26）个月。在一年随访时，29例患者获得良好或优秀结果。没有患者出现大于10°的角形或旋转畸形。一名患有A1型骨折的骨质疏松女性在10周时出现植入物失败并接受了翻修手术。另一名患有A1型骨折的患者在大腿远端外侧持续疼痛，并在22个月时接受了植入物取出术。没有患者发生深部感染、畸形愈合或骨不连。
使用LCP的MIPO对股骨远端骨折实现了良好的生物学固定，并发症较少。即使在干骺端粉碎的情况下也无需植骨。正确的患者选择和术前规划对于预防并发症至关重要。
