双钢板固定股骨的联合率和功能结局：文献系统评价。
Union rates and functional outcome of double plating of the femur: systematic review of the literature.
机构信息
Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert- Schweitzer-Campus 1, 48149, Münster, Germany.
出版信息
Arch Orthop Trauma Surg. 2022 Jun;142(6):1009-1030. doi: 10.1007/s00402-021-03767-6. Epub 2021 Jan 23.
BACKGROUND
The optimal treatment strategy for the surgical management of femur fractures and non-unions remains unknown. The aim of this study is to assess union rates, complications and outcome after femoral double plating. Treatment of shaft, distal, periprosthetic fractures and pathological proximal femur fractures as well as femoral non-unions with double plating were evaluated.
METHODS
A systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was conducted. Published literature reporting on the treatment and clinical outcome of femoral fractures and non-unions with double plating was identified. In total, 24 studies with 436 cases of double plating, 64 cases of single plating, 84 cases of intramedullary nailing (IM), and 1 interfragmentary screw treatment met the inclusion criteria of this systematic review. The evaluated literature was published between 1991 and 2020.
RESULTS
Double plating of femoral fractures achieved high healing rates and few complications were reported. It displayed significantly less intraoperative haemorrhage, shorter surgery time reduced risk of malunion in polytraumatised patients when compared to IM. Fracture healing rate of double-plating distal femoral fractures was 88.0%. However, there were no significant differences regarding fracture healing, complication or functional outcome when compared to single plating. Treatment of periprosthetic fractures with double plating displayed high healing rates (88.5%). Double plating of non-unions achieved excellent osseous union rates (98.5%).
CONCLUSIONS
The literature provides evidence for superior outcomes when using double plating in distal femoral fractures, periprosthetic fractures and femoral non-unions. Some evidence suggests that the use of double plating of femoral fractures in polytraumatised patients may be beneficial over other types of fracture fixation.
LEVEL OF EVIDENCE
IV.
背景
股骨骨折和骨不连的手术治疗策略仍不明确。本研究旨在评估股骨双钢板固定后的愈合率、并发症和转归。评估了股骨干、股骨干远端、假体周围骨折和病理性股骨近端骨折以及股骨骨不连的双钢板治疗。
方法
根据系统评价和荟萃分析的首选报告项目（PRISMA）声明进行系统评价。确定了报告股骨骨折和骨不连双钢板治疗和临床结果的已发表文献。共有 24 项研究符合本系统评价的纳入标准，其中 436 例采用双钢板固定，64 例采用单钢板固定，84 例采用髓内钉（IM）固定，1 例采用骨间螺钉固定。评估的文献发表于 1991 年至 2020 年。
结果
股骨骨折的双钢板固定愈合率高，并发症少。与 IM 相比，双钢板固定术中出血量少，手术时间短，降低了多发伤患者发生畸形愈合的风险。双钢板固定股骨干远端骨折的愈合率为 88.0%。然而，与单钢板固定相比，在骨折愈合、并发症或功能结果方面无显著差异。双钢板固定假体周围骨折的愈合率高（88.5%）。双钢板固定骨不连的骨愈合率优异（98.5%）。
结论
文献提供了证据，证明在股骨干远端骨折、假体周围骨折和股骨骨不连中使用双钢板固定可获得更好的结果。一些证据表明，在多发伤患者中使用股骨骨折的双钢板固定可能优于其他类型的骨折固定。
证据水平
IV 级。
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