Kim Joon-Woo, Oh Chang-Wug, Oh Jong-Keon, Park Il-Hyung, Kyung Hee-Soo, Park Kyeong-Hyeon, Yoon Seong-Dae, Kim Seong-Min
Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea.
Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea.
Injury. 2017 Mar;48(3):751-757. doi: 10.1016/j.injury.2017.01.019. Epub 2017 Jan 10.
Although minimally invasive plate osteosynthesis (MIPO) is a preferred operative treatment for fractures of the distal femur, malalignment is a significant concern because of indirect reduction of the fracture. The purpose of this study, therefore, was to evaluate radiologic alignment after MIPO for distal femoral fractures.
Of the 138 patients with fracture of the distal femur who underwent MIPO, we enrolled 51 patients in whom bilateral rotational alignment could be assessed by postoperative computed tomography (CT). The patients included 32 men and 19 women, with a mean age of 54.3 years. Thirteen patients had femoral shaft fractures (according to the AO/OTA classification: 32-A, n=2; 32-B, n=6; 32-C, n=5), whereas 38 patients had distal femoral fractures (33-A, n=7; 33-C, n=31). Coronal and sagittal alignments were assessed using simple radiography, whereas rotational alignment was assessed using CT. According to the difference between the affected and unaffected sides, we divided the patients into satisfactory and unsatisfactory groups (reference point of 8°, using Handolin's classification). Thereafter, we determined which factors can lead to malalignment, including fracture location (distal femoral shaft fracture or metaphyseal fracture), fracture pattern (simple fracture, n=15; complex fractures, n=36 patients), coronal and sagittal alignments, and combined ipsilateral long bone fractures.
Coronal and sagittal alignment were satisfactory in 96.2% (average, 2.8°) and 98% (average, 2.2°), respectively, whereas the rotational alignment was satisfactory in 56.9% of patients. Leg length discrepancy was satisfactory in 92.3% of the patients (average, 10.9mm). Concerning rotational malalignment, an unsatisfactory result was obtained in 48.6% of subjects with complex fractures and 26.7% of subjects with simple fractures (p=0.114). No significant correlation was noted between the angular deformity in the coronal and sagittal planes and the degree of rotational alignment (p=0.607 and 0.774, respectively).
Regardless of the fracture pattern, rotational malalignment may occur at an extremely high rate after MIPO for fractures of the distal femur.
尽管微创钢板接骨术（MIPO）是股骨远端骨折首选的手术治疗方法，但由于骨折间接复位，对线不良仍是一个重大问题。因此，本研究的目的是评估股骨远端骨折MIPO术后的影像学对线情况。
在138例行MIPO治疗的股骨远端骨折患者中，我们纳入了51例可通过术后计算机断层扫描（CT）评估双侧旋转对线的患者。患者包括32名男性和19名女性，平均年龄54.3岁。13例患者为股骨干骨折（根据AO/OTA分类：32-A，n=2；32-B，n=6；32-C，n=5），而38例患者为股骨远端骨折（33-A，n=7；33-C，n=31）。冠状面和矢状面对线通过简单X线片评估，而旋转对线通过CT评估。根据患侧与健侧的差异，我们将患者分为满意组和不满意组（参考点为8°，采用汉多林分类法）。此后，我们确定了哪些因素可导致对线不良，包括骨折部位（股骨干远端骨折或干骺端骨折）、骨折类型（简单骨折，n=15；复杂骨折，n=36例患者）、冠状面和矢状面对线以及同侧合并长骨骨折。
冠状面和矢状面对线分别在96.2%（平均2.8°）和98%（平均2.2°）的患者中满意，而旋转对线在56.9%的患者中满意。92.3%的患者下肢长度差异满意（平均差10.9mm）。关于旋转对线不良，48.6%的复杂骨折患者和26.7%的简单骨折患者结果不满意（p=0.114）。冠状面和矢状面的角畸形与旋转对线程度之间无显著相关性（分别为p=0.607和0.774）。
无论骨折类型如何，股骨远端骨折MIPO术后旋转对线不良的发生率可能极高。
