Tucker A, Diamond O, McDonald S, Johnston A, Neil M, Kealey D, Archbold P
Royal Victoria Hospital, Belfast, United Kingdom.
Royal Victoria Hospital, Belfast, United Kingdom.
Injury. 2016 Oct;47(10):2173-2181. doi: 10.1016/j.injury.2016.06.016. Epub 2016 Jun 11.
The Variable angle Martin Plate (MP) is designed to offer patient-specific adaption for the treatment of intertrochanteric hip fractures. Its proposed benefits include optimization of lag screw placement, plate shaft congruence and reduced risk of failure. Often its use has been criticized as representing a poor reduction of the fracture. The purpose of this study was to assess for a poorer quality of reduction, and compare functional outcomes and mortality, using a MP to that of a fixed angle Dynamic Hip Screw (DHS) in a matched cohort of patients.
A retrospective review of a prospective fracture database system was undertaken between 1st January 2004 to 31st December 2013. MP patients were matched to a cohort of DHS patients. Outcomes measure were a quality of procedure score(QPS), 1-year mortality rates, reoperation rates, and Barthel Index functional outcome. Minimum follow up was 12 months.
A total of 77 Martin Plate patients were identified and case matched. The mean pre- and post-op Neck Shaft Angle (NSA) in the MPs was significantly different (132.97±7.78 Vs 126±8.62; p<0.0001). Conversely, the mean pre op DHS NSA and the mean post op NSA was not (p=0.397). Mean Tip-Apex Distance (TAD) was significantly different between groups; MP mean 26.51±9.09mm vs DHS 23.50±8.14mm (p=0.023). The QPS consisted of 4 variables. A significant inverse relationship between QPS and the incidence of construct related complications exists. TAD>25mm, and a change in AP NSA of >5°conveyed the greatest risk of complications. No difference occurred in complications, nor 12-month mortality.
No statistical difference was found in the quality of reduction between MP and DHS in this group of matched patients. QPS demonstrated a significant inverse correlation with implant-related complications. No significant difference was noted in the incidence of complications, Barthel Index functional scores, or 12-month mortality between implants. A rationale exists regarding the use of MPs, particularly in patients with varus NSA. However, planning and adequate reduction are essential regardless of implant choice.
可变角度马丁钢板（MP）旨在为转子间髋部骨折的治疗提供针对患者的适应性。其预期优势包括拉力螺钉置入的优化、钢板骨干的一致性以及降低失败风险。但其使用常常受到批评，认为其骨折复位效果不佳。本研究的目的是评估使用MP与固定角度动力髋螺钉（DHS）在匹配队列患者中的骨折复位质量是否较差，并比较功能结局和死亡率。
对2004年1月1日至2013年12月31日期间的前瞻性骨折数据库系统进行回顾性研究。将MP患者与一组DHS患者进行匹配。结局指标包括手术质量评分（QPS）、1年死亡率、再次手术率和巴氏指数功能结局。最短随访时间为12个月。
共确定了77例马丁钢板患者并进行病例匹配。MP组术前和术后的平均颈干角（NSA）有显著差异（132.97±7.78对126±8.62；p<0.0001）。相反，DHS组术前平均NSA与术后平均NSA无显著差异（p=0.397）。两组间平均尖顶距（TAD）有显著差异；MP组平均为26.51±9.09mm，DHS组为23.50±8.14mm（p=0.023）。QPS由4个变量组成。QPS与内固定相关并发症的发生率之间存在显著的负相关关系。TAD>25mm以及前后位NSA变化>5°提示并发症风险最高。并发症发生率和12个月死亡率无差异。
在这组匹配患者中，MP和DHS的复位质量无统计学差异。QPS与植入物相关并发症呈显著负相关。植入物之间的并发症发生率、巴氏指数功能评分或12个月死亡率无显著差异。对于MP的使用存在一定的理论依据，尤其是在内翻NSA的患者中。然而，无论选择何种植入物，规划和充分复位都是至关重要的。
