Harvin William H, Oladeji Lasun O, Della Rocca Gregory J, Murtha Yvonne M, Volgas David A, Stannard James P, Crist Brett D
University of Texas Health Sciences Center at Houston, Department of Orthopaedic Surgery, 6431 Fannin Street, Houston, TX 77030, USA.
University of Missouri School of Medicine, Department of Orthopaedic Surgery, One Hospital Drive, N119, Columbia, MO 65212, USA.
Injury. 2017 Nov;48(11):2597-2601. doi: 10.1016/j.injury.2017.08.064. Epub 2017 Sep 1.
The study purpose is to evaluate the working length, proximal screw density, and diaphyseal fixation mode and the correlation to fracture union after locking plate osteosynthesis of distal femoral fractures using bridge-plating technique.
A four-year retrospective review was performed to identify patients undergoing operative fixation of distal femur fractures with a distal femoral locking plate using bridge-plating technique for the metadiaphyseal region. Primary variables included fracture union, secondary surgery for union, plate working length, and diaphyseal screw technique and configuration. Multiple secondary variables including plate metallurgy and coronal plane fracture alignment were also collected.
Ninety-six patients with distal femur fractures with a mean age 60 years met inclusion criteria. None of the clinical parameters were statistically significant indicators of union. Likewise, none of the following surgical technique parameters were associated with fracture union: plate metallurgy, the mean working length, screw density and number of proximal screws and screw cortices. However, diaphyseal screw technique did show statistical significance. Hybrid technique had a statistically significant higher chance of union when compared to locking (p=0.02). All proximal locking screw constructs were 2.9 times more likely to lead to nonunion.
Plating constructs with all locking screws used in the diaphysis when bridge-plating distal femur locking plates were 2.9 times more likely to incur a nonunion. However, other factors associated with more flexible fixation constructs such as increased working length, decreased proximal screw number, and decreased proximal screw density were not significantly associated with union in this study.
本研究目的是评估采用桥接钢板技术进行股骨远端骨折锁定钢板内固定术后的工作长度、近端螺钉密度、骨干固定方式及其与骨折愈合的相关性。
进行了一项为期四年的回顾性研究，以确定采用桥接钢板技术对股骨干骺端区域的股骨远端骨折进行手术固定的患者。主要变量包括骨折愈合情况、促进愈合的二次手术、钢板工作长度、骨干螺钉技术及构型。还收集了多个次要变量，包括钢板材质和冠状面骨折对线情况。
96例平均年龄60岁的股骨远端骨折患者符合纳入标准。没有任何临床参数是愈合的统计学显著指标。同样，以下手术技术参数均与骨折愈合无关：钢板材质、平均工作长度、螺钉密度、近端螺钉数量及螺钉皮质数量。然而，骨干螺钉技术确实具有统计学意义。与锁定技术相比，混合技术的愈合几率在统计学上显著更高（p = 0.02）。所有近端锁定螺钉构型导致骨不连的可能性高出2.9倍。
在桥接钢板固定股骨远端骨折时，骨干使用全锁定螺钉的钢板构型发生骨不连的可能性高出2.9倍。然而，在本研究中，其他与更灵活固定构型相关的因素，如工作长度增加、近端螺钉数量减少和近端螺钉密度降低，与骨折愈合并无显著关联。
