Vandenbussche E, LeBaron M, Ehlinger M, Flecher X, Pietu G
Service de chirurgie orthopédique et traumatologique, université René-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
Service de chirurgie orthopédique, hôpital Nord, Assistance Publique des Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France.
Orthop Traumatol Surg Res. 2014 Sep;100(5):555-60. doi: 10.1016/j.otsr.2014.06.006. Epub 2014 Aug 14.
The blade-plate is the earliest of the contemporary internal fixation devices introduced for distal femoral fractures. The recent development of dedicated, fixation devices has considerably limited its use. The objective of this study was to evaluate outcomes after blade-plate fixation and after fixation using other devices.
Outcomes after blade-plate fixation are similar to those after condylar screw-plate, distal femoral nail, or locking condylar plate fixation.
We reviewed outcomes after 62 patients managed with blade-plate fixation and included in a multicentre retrospective study (n=57) or a multicentre prospective study (n=5) and we compared them to outcomes after fixation using condylar screw-plates (n=82), distal femoral nail (n=219), or locking condylar plates (n=301). The four groups were comparable for age, gender distribution, occupational status, prevalence of skin wounds, patient-related factors, type of accident, and type of fracture. The evaluation relied on the clinical International Knee Society (IKS) score and on radiographs.
No significant differences existed across the four groups for operative time, blood transfusion use, complications, need for bone grafting, non-union rate, or IKS score values. The early surgical revision rate for removal of the fixation material was 4% with the blade-plate and 16% with the other three fixation devices (P=0.02). Post-operative fracture deformity was similar in the four groups with, however, a higher proportion of residual malalignment in the screw-fixation group. The final anatomic axis was 3.3±1.4° with the blade-plate versus 2.3±3.7° with the other three fixation devices. The blade-plate group had few patients with axial malalignment, and the degree of malalignment was limited to 3° of varus and 10° of valgus at the most, compared to 10° and 18° respectively, with the other three fixation devices.
Despite the now extremely limited use and teaching of blade-plate fixation, as well as the undeniable technical challenges raised by the implantation of this device, the blade-plate is a simple, strong, and inexpensive fixation method. It remains reliable for the fixation of distal femoral fractures. The disfavour into which the blade-plate is currently falling is not warranted.
III, case-control study.
接骨板是当代最早用于股骨远端骨折的内固定器械。近年来，专用固定器械的发展极大地限制了其应用。本研究的目的是评估接骨板固定与其他器械固定后的疗效。
接骨板固定后的疗效与髁螺钉接骨板、股骨远端髓内钉或锁定髁接骨板固定后的疗效相似。
我们回顾了62例接受接骨板固定患者的治疗结果，这些患者纳入了一项多中心回顾性研究（n = 57）或一项多中心前瞻性研究（n = 5），并将其与使用髁螺钉接骨板（n = 82）、股骨远端髓内钉（n = 219）或锁定髁接骨板（n = 301）固定后的疗效进行比较。四组在年龄、性别分布、职业状况、皮肤伤口发生率、患者相关因素、事故类型和骨折类型方面具有可比性。评估依赖于临床国际膝关节协会（IKS）评分和X线片。
四组在手术时间、输血使用、并发症、植骨需求、骨不连发生率或IKS评分值方面均无显著差异。接骨板取出内固定材料的早期手术翻修率为4%，其他三种固定器械为16%（P = 0.02）。四组术后骨折畸形相似，但螺钉固定组残余对线不良的比例更高。接骨板组最终解剖轴线为3.3±1.4°，其他三种固定器械为2.3±3.7°。接骨板组轴向对线不良的患者较少，对线不良程度最多限于内翻3°和外翻10°，而其他三种固定器械分别为10°和18°。
尽管目前接骨板固定的应用和教学极其有限，且该器械植入带来的技术挑战不可否认，但接骨板是一种简单、坚固且廉价的固定方法。它对于股骨远端骨折的固定仍然可靠。接骨板目前不受青睐是没有道理的。
III级，病例对照研究。
