Shin Won Chul, Moon Nam Hoon, Jang Jae Hoon, Lee Hee Jin, Suh Kuen Tak
Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
Department of Orthopaedic Surgery, (Bio)Medical Research Institute, Pusan National University Hospital, Busan, Korea.
Injury. 2017 Oct;48(10):2207-2213. doi: 10.1016/j.injury.2017.08.028. Epub 2017 Aug 19.
The objective of this study is to evaluate the outcome measures of subtrochanteric fractures between biologic plating and intramedullary nailing and determine if biologic plating is superior to intramedullary nailing.
Between March 2009 and December 2015, 81 patients with subtrochanteric fractures were enrolled (52 males and 29 females; 31 treated with biologic plating and 50 with intramedullary nailing). Biologic plating was conducted consecutively between May 2011 and March 2013 and intramedullary nailing was performed for the rest of period. Perioperative outcomes including operation time and blood loss during the operation; postoperative radiologic outcomes including union, time to union, coronal alignment, and shortening of the femur; and clinical outcomes including walking ability and pain were evaluated. The biologic plating group was compared with the intramedullary nailing group as a historical control.
No significant differences were identified for bony union and time to union between the two different fixation methods Coronal alignment was significantly better in the biologic plating group than in the intramedullary nailing group (p<0.016). Postoperative coronal alignment was the only risk factor associated with the nonunion of subtrochanteric fractures (unadjusted OR: 1.915, 95% CI: 0.190 - 19.273; adjusted OR: 0.042, 95% CI: 0.000 - 21.517; p=0.320).
Surgical outcomes using LCP-DF are comparable to those using intramedullary nailing. Further clinical studies with a larger sample size are required to show the advantage of biologic plating for the treatment of subtrochanteric fractures.
本研究的目的是评估生物钢板固定与髓内钉固定治疗股骨转子下骨折的疗效指标，并确定生物钢板固定是否优于髓内钉固定。
2009年3月至2015年12月，纳入81例股骨转子下骨折患者（男52例，女29例；31例行生物钢板固定，50例行髓内钉固定）。2011年5月至2013年3月连续进行生物钢板固定，其余时间行髓内钉固定。评估围手术期结果，包括手术时间和术中失血；术后影像学结果，包括骨折愈合、愈合时间、冠状位对线和股骨短缩；以及临床结果，包括行走能力和疼痛。将生物钢板固定组与髓内钉固定组作为历史对照进行比较。
两种不同固定方法在骨愈合和愈合时间方面未发现显著差异。生物钢板固定组的冠状位对线明显优于髓内钉固定组（p<0.016）。术后冠状位对线是股骨转子下骨折不愈合的唯一相关危险因素（未调整的OR：1.915，95%CI：0.190 - 19.273；调整后的OR：0.042，95%CI：0.000 - 21.517；p=0.320）。
使用锁定加压钢板（LCP-DF）的手术效果与髓内钉固定相当。需要进一步进行更大样本量的临床研究来显示生物钢板固定治疗股骨转子下骨折的优势。
