Dumpies C W, Conrad T, Marintschev I, Hofmann G O
Klinik für Unfall- und Wiederherstellungschirurgie, BG-Kliniken Bergmannstrost, Halle (Saale).
Z Orthop Unfall. 2012 Jun;150(3):302-8. doi: 10.1055/s-0031-1298530. Epub 2012 Jun 21.
In this paper we present our first experience in the application of a new, fixed-angle plate fixation: the locking attachment plate (LAP, Synthes, Oberdorf, Switzerland). We examined whether the LAP is a useful addition to the existing technical palette for periprosthetic fractures. The LAP is used for periprosthetic fractures with stable prostheses or intramedullary implants. The plate can be installed, e.g., on a 4.5 mm locking compression plate (LCP). Locking screws or cortical screws can be placed through its 4 diagonal fixed-angle arms, bicortical around the prosthesis stem into the bone. The LAP is designed to prevent lateral screw pull-out, to stabilise the prosthesis stem and thus to allow early postoperative mobilisation of patients.
We implanted the LAP by operative fracture-treatment in the ORIF technique in 17 patients with periprosthetic fractures of the femur, tibia and humerus. The follow-up was at least 13 months.
There were two losses to follow-up: the patients died a few weeks postoperatively. There was a total of two of 17 cases with infection events (11.8 %). We could examine 15 patients for follow-up. Eleven of these 15 patients regained their original range of motion (ROM) and nine of 15 patients their pretraumatic mobility. In all cases with periprosthetic humeral fractures we detected muscular deficits. In five out of 15 cases (33.3 %) no radiological fracture healing could be observed. Nevertheless in 14 of 15 cases the implant was stable without signs of implant or prosthetic loosening. There was no case of material failure.
Periprosthetic fractures are an increasingly common complication in old, often multi-morbid patients. A contemporary therapeutic intervention and early postoperative mobilisation contribute substantially to the success of treatment. The first results in the use of the LAP as a new implant option for periprosthetic fractures of the femur, tibia and humerus are promising. Further studies are necessary to show whether our overall good results are reproducible in larger groups of patients and whether the LAP can be given a firm position in the technical repertoire for treatment of periprosthetic fractures.
在本文中，我们介绍了应用一种新型固定角度钢板固定术——锁定附着钢板（LAP，Synthes公司，瑞士奥伯dorf）的首次经验。我们研究了LAP是否是现有假体周围骨折技术方法的有益补充。LAP用于假体稳定或髓内植入物的假体周围骨折。该钢板例如可安装在4.5毫米锁定加压钢板（LCP）上。锁定螺钉或皮质螺钉可通过其4个对角固定角度臂置入，双皮质穿过假体柄周围进入骨内。LAP旨在防止螺钉侧向拔出，稳定假体柄，从而使患者术后能早期活动。
我们采用切开复位内固定技术，对17例股骨、胫骨和肱骨假体周围骨折患者植入LAP。随访时间至少13个月。
有2例失访：患者术后几周死亡。17例中共有2例发生感染事件（11.8%）。我们对15例患者进行了随访检查。这15例患者中有11例恢复了原来的活动范围（ROM），15例患者中有9例恢复了创伤前的活动能力。在所有假体周围肱骨骨折病例中，我们都检测到了肌肉功能缺陷。15例中有5例（33.3%）未观察到放射学骨折愈合。然而，15例中有14例植入物稳定，无植入物或假体松动迹象。没有材料失效的情况。
假体周围骨折在老年、往往患有多种疾病的患者中是一种日益常见的并发症。当代的治疗干预和术后早期活动对治疗成功有很大贡献。将LAP作为股骨、胫骨和肱骨假体周围骨折的一种新的植入选择的初步结果很有前景。需要进一步研究以表明我们的总体良好结果在更大的患者群体中是否可重复，以及LAP能否在假体周围骨折治疗的技术方法中占据稳固地位。
