Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Injury. 2020 Feb;51(2):452-456. doi: 10.1016/j.injury.2019.12.015. Epub 2019 Dec 10.
The incidence of arterial injury associated with femoral fractures is approximately 1%. Lateral sub-muscular plate fixation is gaining popularity for the management of distal femoral fractures. The objective of this study was to assess the iatrogenic risk to the superficial femoral artery (SFA) during Less Invasive Stabilisation System (LISS) plate fixation of distal femoral fractures by analysing the range of distances and angles between LISS plate screws and the drilling line to the SFA.
We identified all patients who underwent LISS plate fixation of distal femoral fractures between 2008 and 2018 in our level-1 trauma centre. Patients who underwent postoperative computed tomography for any reason were eligible for inclusion in the study. Twenty-five patients met the inclusion criteria. The sample comprised 10 male and 15 female patients with a mean age of 55 years. The most common fracture type was a supracondylar femur fracture (56%), followed by an intercondylar fracture (36%). A 13-hole LISS plate was the most common plate length used (44%). A consultant radiologist reviewed all scans to verify the visibility and marking of the SFA.
The median distance between the screw tip and the SFA was 21 mm (range, 8-65 mm). There was a negative correlation between the LISS plate hole number and the trajectory of drilling (Pearson coefficient: -0.87, p < 0.001). Using a linear regression model, the SFA was more likely to be in the line of drilling when the 6th to 10th holes in the LISS plate were used.
Extra care is needed when drilling into the LISS plate holes from the lateral to the medial direction in order to reduce the risk of iatrogenic injury to the SFA, especially in the high-risk plate zone where the artery can be close to the drilling line.
股骨干骨折相关动脉损伤的发生率约为 1%。外侧肌下钢板固定技术在治疗股骨远端骨折方面越来越受欢迎。本研究的目的是通过分析股骨远端骨折 LISS 钢板固定时 LISS 钢板螺钉与股浅动脉（SFA）钻孔线之间的距离和角度范围，评估 LISS 钢板固定时 SFA 的医源性损伤风险。
我们在我们的 1 级创伤中心确定了所有在 2008 年至 2018 年期间接受 LISS 钢板固定股骨远端骨折的患者。所有因任何原因接受术后计算机断层扫描的患者均符合纳入本研究的条件。25 名患者符合纳入标准。该样本包括 10 名男性和 15 名女性患者，平均年龄为 55 岁。最常见的骨折类型是髁上股骨骨折（56%），其次是髁间骨折（36%）。最常用的钢板长度是 13 孔 LISS 钢板（44%）。一位顾问放射科医师审查了所有扫描图像以验证 SFA 的可见性和标记。
螺钉尖端与 SFA 之间的中位数距离为 21mm（范围 8-65mm）。LISS 钢板孔数与钻孔轨迹之间存在负相关（皮尔逊系数：-0.87，p<0.001）。使用线性回归模型，当 LISS 钢板的第 6 至 10 个孔用于钻孔时，SFA 更有可能位于钻孔线中。
在从外侧向内侧钻入 LISS 钢板孔时需要格外小心，以降低 SFA 医源性损伤的风险，特别是在靠近钻孔线的高危钢板区域。
