Orthopedic Trauma Service, Department of Orthopedics, Vanderbilt Medical Center, Nashville, TN 37232, USA.
J Orthop Trauma. 2013 Jan;27(1):22-8. doi: 10.1097/BOT.0b013e318251930d.
The aim of this study was analyze modes of mechanical failure in a consecutive cohort of patients and establish possible risk factors.
This was a retrospective cohort study.
The study was conducted at an academic level-1 trauma center.
Twenty-nine patients (mean age 56 years, range 21-92; 45% males, 41% smokers, 17% diabetic, mean body mass index 26.9, range 20-56) with 30 OTA 31A3 fractures treated between 2003 and 2007 were included.
Operative fixation using 4.5-mm locking compression plate (LCP) proximal femur plate (Synthes, Paoli, PA).
Mechanical failure was defined as loss of alignment of at least 10° or shortening of at least 2 cm. Secondary outcomes included patient and fixation construct variables as possible predictors for mechanical failure.
At 20 months of follow-up, 11 failures (37%) occurred. Mean time to failure was 18 weeks (range 2-84). Cumulative failure rates were 10%, 20%, 27%, and 33% at 1, 2, 6, and 12 months, respectively. The most frequent failure mode was varus collapse with screw cut out (5 cases). There was no statistically significant difference between groups with regards to age, body mass index, diabetes, or smoking habit. The presence of a "kickstand screw" and medial cortical reduction were not significantly different in cases with and without failure. Proximal screw number and type were similar in both groups.
A high rate of mechanical failure can be expected with proximal locking plate fixation of unstable proximal femur fractures. The use of a "kickstand" screw could not be established to reduce the risk for mechanical failure.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在分析连续队列患者的机械故障模式，并确定可能的危险因素。
这是一项回顾性队列研究。
研究在一家学术水平为 1 级的创伤中心进行。
29 例 OTA 31A3 骨折患者（平均年龄 56 岁，范围 21-92；45%为男性，41%为吸烟者，17%为糖尿病患者，平均体重指数为 26.9，范围 20-56），于 2003 年至 2007 年间接受 4.5 毫米锁定加压钢板（LCP）股骨近端钢板（Synthes，Paoli，PA）手术固定治疗。
采用 4.5 毫米锁定加压钢板（LCP）股骨近端钢板（Synthes，Paoli，PA）进行手术固定。
机械故障定义为至少 10°的对线丢失或至少 2cm 的缩短。次要结果包括患者和固定结构变量，作为机械故障的可能预测因素。
在 20 个月的随访中，发生了 11 例（37%）失败。平均失败时间为 18 周（范围 2-84 周）。在 1、2、6 和 12 个月时，累积失败率分别为 10%、20%、27%和 33%。最常见的失败模式是内翻塌陷和螺钉切出（5 例）。在年龄、体重指数、糖尿病或吸烟习惯方面，两组之间没有统计学上的显著差异。“支架螺钉”的存在和内侧皮质复位在有和无失败的病例中没有显著差异。两组近端螺钉数量和类型相似。
不稳定型股骨近端骨折采用近端锁定钢板固定可导致较高的机械故障发生率。使用“支架”螺钉并不能降低机械故障的风险。
治疗水平 IV。有关证据水平的完整描述，请参见作者说明。
