Ricci William M, Streubel Philipp N, Morshed Saam, Collinge Cory A, Nork Sean E, Gardner Michael J
*Orthopaedic Trauma Service, Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, MO; †Mayo Clinic, Rochester, MN; ‡Orthopaedic Trauma Institute, University of California San Francisco, San Francisco General Hospital, San Francisco, CA; §Harris Methodist Fort Worth Hospital, John Peter Smith Orthopaedic Surgery Residency Program, Fort Worth, TX; and ‖Department of Orthopaedics, Harborview Medical Center, Seattle, WA.
J Orthop Trauma. 2014 Feb;28(2):83-9. doi: 10.1097/BOT.0b013e31829e6dd0.
OBJECTIVES: Locked plating has become a standard method to treat supracondylar femur fractures. Emerging evidence indicates that this method of treatment is associated with modest failure rates. The goals of this study were to determine risk factors for complications and to provide technical recommendations for locked plating of supracondylar femur fractures. DESIGN: Retrospective review. SETTING: Three level I or II trauma centers. PATIENTS/PARTICIPANTS: Three hundred twenty-six patients with 335 distal femur fractures (OTA 33A or C, 33% open) treated with lateral locked plates were studied. The average patient age was 57 years (range 17-97 years), 55% were women, 34% were obese, 19% were diabetic, and 24% were smokers. INTERVENTION: All patients were managed with open reduction internal fixation using a lateral distal femoral locked plate construct that included locked screws in the distal fragment and nonlocked, locked, or a combination of locked and nonlocked screws in the proximal fragment. MAIN OUTCOME MEASUREMENTS: Risk factors for reoperation to promote union, deep infection, and implant failure. RESULTS: After the index procedure, 64 fractures (19%) required reoperation to promote union, including 30 that had a planned staged bone grafting because of the metaphyseal defect after debridement of an open fracture. Independent risk factors for reoperation to promote union and deep infection included diabetes and open fracture. Risk factors for proximal implant failure included open fracture, smoking, increased body mass index, and shorter plate length. CONCLUSIONS: The identified risk factors for reoperation to promote union and complications included open fracture, diabetes, smoking, increased body mass index, and shorter plate length. Most factors are out of surgeon control but are useful when considering prognosis. Use of relatively long plates is a technical factor that can reduce risk for fixation failure. LEVEL OF EVIDENCE: Prognostic level II. See instructions for authors for a complete description of levels of evidence.
目的：锁定钢板已成为治疗股骨髁上骨折的标准方法。新出现的证据表明，这种治疗方法的失败率适中。本研究的目的是确定并发症的危险因素，并为股骨髁上骨折的锁定钢板固定提供技术建议。 设计：回顾性研究。 地点：三个一级或二级创伤中心。 患者/参与者：对326例患者的335例股骨远端骨折（OTA 33A或C型，33%为开放性骨折）采用外侧锁定钢板治疗进行研究。患者平均年龄为57岁（范围17 - 97岁），55%为女性，34%为肥胖者，19%患有糖尿病，24%为吸烟者。 干预措施：所有患者均采用切开复位内固定，使用股骨远端外侧锁定钢板结构，远端骨折块使用锁定螺钉，近端骨折块使用非锁定、锁定或锁定与非锁定螺钉组合。 主要观察指标：促进骨折愈合的再次手术、深部感染和内固定失败的危险因素。 结果：初次手术后，64例骨折（19%）需要再次手术以促进骨折愈合，其中30例因开放性骨折清创后干骺端缺损而进行了计划性分期植骨。促进骨折愈合和深部感染再次手术的独立危险因素包括糖尿病和开放性骨折。近端内固定失败的危险因素包括开放性骨折、吸烟、体重指数增加和钢板长度较短。 结论：已确定的促进骨折愈合再次手术和并发症的危险因素包括开放性骨折、糖尿病、吸烟、体重指数增加和钢板长度较短。大多数因素超出外科医生的控制范围，但在考虑预后时很有用。使用相对较长的钢板是一个可以降低固定失败风险的技术因素。 证据级别：预后II级。有关证据级别的完整描述，请参阅作者指南。
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