微创钢板接骨术与切开复位内固定联合锁定钢板和骨间螺钉治疗股骨远端骨折的疗效比较。

Outcomes of distal femoral fractures treated with minimally invasive plate osteosynthesis versus open reduction internal fixation with combined locking plate and interfragmentary screws.

机构信息

Department of Orthopaedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC; Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan, ROC.

Department of Orthopaedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.

出版信息

Int J Surg. 2019 May;65:107-112. doi: 10.1016/j.ijsu.2019.03.019. Epub 2019 Apr 2.

DOI:10.1016/j.ijsu.2019.03.019

PMID:30951872

Abstract

PURPOSE

Fractures of the distal femur remain challenging to treat, and numerous fixation methods are designed to promote stability and fracture healing. Locking plate constructs have recently become the mainstream fixation method, but debate exists on whether to use locking plates alone or to augment them with interfragmentary screws. This article compares outcomes of distal femur fractures treated with a single locking plate alone versus those treated with a locking plate and interfragmentary screws.

METHODS

We retrospectively reviewed 57 patients treated for distal femur fractures from 2010 to 2013. Patients were divided into two groups: Those treated with a locking plate alone utilizing the minimally invasive plate osteosynthesis (MIPO) technique and those treated with combination of a locking plate and interfragmentary screws using an open technique. Postoperative outcomes were obtained via a manual chart review. Fracture healing and callus indices were evaluated from radiographs.

RESULTS

9 patients required revision surgery in the locking plate alone group (6 for persistent nonunion and 3 for varus deformity). Only two patients in the combination group required revisions (both for nonunion). Average time to full weight bearing was 19.54 weeks in the locking plate group versus 14.57 weeks in the combination group (p = 0.004). At the time of full weight bearing, frontal (1.15 versus 1.11, p = 0.004) and sagittal (1.22 versus 1.15, P = 0.008) callus indices were both significantly greater in the locking plate group.

CONCLUSIONS

In this study, the combination of a locking plate and interfragmentary screws achieved suitable stability and a faster time to full weight bearing than using a locking plate alone. Surgeons should consider combining a locking plate with interfragmentary screws as an effective method for fixation of distal femur fractures, particularly in cases when plate fixation alone fails to provide adequate fracture stability.

摘要

目的

股骨远端骨折的治疗仍然具有挑战性，有许多固定方法旨在促进稳定性和骨折愈合。锁定钢板结构最近已成为主流固定方法，但关于是否单独使用锁定钢板或用骨间螺钉增强它们存在争议。本文比较了单独使用锁定钢板和使用锁定钢板加骨间螺钉治疗股骨远端骨折的结果。

方法

我们回顾性分析了 2010 年至 2013 年期间治疗的 57 例股骨远端骨折患者。患者分为两组：一组单独使用锁定钢板（采用微创钢板接骨术[MIPO]技术）治疗，另一组采用锁定钢板加骨间螺钉（采用开放技术）联合治疗。通过手工图表回顾获得术后结果。从影像学上评估骨折愈合和骨痂指数。

结果

单独使用锁定钢板组有 9 例（6 例为持续性骨不连，3 例为内翻畸形）需要翻修手术，联合组只有 2 例（均为骨不连）需要翻修。单独使用锁定钢板组完全负重的平均时间为 19.54 周，联合组为 14.57 周（p=0.004）。在完全负重时，锁定钢板组的额状面（1.15 比 1.11，p=0.004）和矢状面（1.22 比 1.15，P=0.008）骨痂指数均显著更大。