Morochovič Radoslav, Takáčová Katarína, Tomčovčík Ľuboš, Cibur Peter, Burda Rastislav
Department of Trauma Surgery, Faculty of Medicine P.J.Šafárik University, University Hospital of L. Pasteur, Rastislavova 43, 041 90, Košice, Slovakia.
Department of Trauma Surgery, University Hospital of L. Pasteur, Rastislavova 43, 041 90, Košice, Slovakia.
Arch Orthop Trauma Surg. 2019 May;139(5):629-638. doi: 10.1007/s00402-018-03103-5. Epub 2019 Jan 8.
The purpose of this study was to determine factors that affect the early failure of femoral neck fracture healing after internal fixation with a dynamic locking plate implant.
Retrospective analysis of all cases of femoral neck fracture (FNF) primarily treated with dynamic locking plate implant from 04/2014 to 04/2017 with a minimum of 6 month follow-up. For the purpose of the study age, sex and time from admission to surgery were retrieved from the hospital medical database. Patient's pre- and postoperative hip radiographs were reviewed by the authors. Radiographically detected fracture healing failure (non-union and screw cut-out) was recorded.
For the period of the study, there were 77 consecutive FNF (76 patients) treated with the dynamic locking plate implant. Eight (10%) patients were lost to follow-up, 13 (17%) patients died within 6 months after surgery. Healing failure was identified in 23 (41%) of remaining 56 cases. Three of four (75% failure rate) failures were observed in cases with fair-quality reduction and two of two (100% failure rate) failures were noticed in the case of none telescoping screw located within subchondral bone. Multiple logistic regression showed an increased risk of fracture failure in cases with at least one completely collapsed telescoping screw (OR = 73.2; 95% CI 9.4-568.5, p < 0.01), while telescoping screws' location around centre of the femoral head reduces the risk of failure (OR = 14.7; 95% CI 1.6-135.1, p = 0.02).
In our group of patients, fracture healing failure of the FNF treated with dynamic locking plate reached 41%. This high failure rate was associated with poor fracture reduction, not subchondrally and centrally placed telescoping screws and in the case of complete collapse on at least one of the telescoping screws.
本研究的目的是确定影响使用动力锁定钢板植入物内固定后股骨颈骨折愈合早期失败的因素。
对2014年4月至2017年4月期间主要采用动力锁定钢板植入物治疗的所有股骨颈骨折（FNF）病例进行回顾性分析，随访时间至少为6个月。为了本研究的目的，从医院医疗数据库中获取年龄、性别和入院至手术的时间。作者对患者术前和术后的髋关节X光片进行了复查。记录影像学检测到的骨折愈合失败情况（骨不连和螺钉穿出）。
在研究期间，连续有77例FNF（76例患者）接受了动力锁定钢板植入物治疗。8例（10%）患者失访，13例（17%）患者在术后6个月内死亡。在其余56例病例中，有23例（41%）出现愈合失败。在复位质量一般的病例中，观察到四分之三（失败率75%）的失败情况，在软骨下骨内无加压螺钉的病例中，观察到两例（失败率100%）的失败情况。多因素逻辑回归显示，至少有一枚完全塌陷的加压螺钉的病例骨折失败风险增加（OR = 73.2；95% CI 9.4 - 568.5，p < 0.01），而加压螺钉在股骨头中心周围的位置可降低失败风险（OR = 14.7；95% CI 1.6 - 135.1，p = 0.02）。
在我们的患者群体中，使用动力锁定钢板治疗的FNF骨折愈合失败率达到41%。这种高失败率与骨折复位不佳、软骨下和中心位置无加压螺钉以及至少一枚加压螺钉完全塌陷有关。
