Aliev T, Zagorodny N, Lazko F, Belyak E, Aliev R
Peoples' Friendship University of Russia, Moscow; Moscow City Clinical Hospital after V.M. Buyanov, Moscow, Russia.
Georgian Med News. 2021 Dec(321):12-18.
This study compares the results of treatment of two groups of patients who underwent osteosynthesis of intra-articular fractures of the distal femur using the LCP plate and an intramedullary retrograde nail. 89 patients with fractures of the distal femur were divided into 2 groups: group I (n=43) - patients who underwent osteosynthesis of intra-articular fractures of the distal femur using an LCP bone plate and group II (n=46) - using an intramedullary retrograde pin. The comparison was carried out according to the duration of the surgical operation, the amount of time elapsed from the moment of injury to surgery, and blood loss. In group II with intramedullary osteosynthesis, the time of surgical treatment was statistically significantly less than in the group of bone osteosynthesis - 45 minutes and 65 minutes, respectively. Reducing the duration of the operation leads to better functional treatment results. The reduction of the operation time when installing a retrograde intramedullary pin is due to the easier installation technique of this type of retainer and the use of minimally invasive approaches.In patients after surgical interventions, complications were detected in both groups. The nature and frequency of complications in the groups are approximately the same. Infectious complications in the early postoperative period occurred in 4 (9.3%) patients in the group of bone osteosynthesis and 4 (8.6%) - in the group of intramedullary osteosynthesis. In all cases, superficial infection of the postoperative wound within the skin and subcutaneous fat was noted. In the group of bone osteosynthesis, 2 (4.6%) patients in the long-term period were diagnosed with a deep infection of the femoral osteosynthesis area, which required repeated surgical intervention. No cases of deep infection were recorded in the intramedullary osteosynthesis group.In the group of patients who underwent bone osteosynthesis, osteoarthritis of the knee joint of the I degree was detected in 35 (81.4%) patients, in 8 (18.6%) - after 3.5 years of follow-up, the formation of osteoarthritis of the II degree was noted. In the group of patients using intramedullary osteosynthesis, grade I arthrosis was detected in 36 (78.2%) patients, and grade II - in 10 (21.8%) patients. 3,5 years after the operation, there was no need for knee replacement in any patient.The retrograde intramedullary osteosynthesis technique of femoral condyle fractures in the long-term period revealed the best functional indicators.
本研究比较了两组采用锁定加压钢板（LCP）和逆行髓内钉治疗股骨远端关节内骨折患者的治疗结果。89例股骨远端骨折患者被分为2组：第一组（n = 43）——采用LCP骨板治疗股骨远端关节内骨折的患者；第二组（n = 46）——采用逆行髓内针治疗的患者。根据手术操作时间、受伤至手术的时间间隔以及失血量进行比较。在采用髓内固定的第二组中，手术治疗时间在统计学上显著少于骨固定组，分别为45分钟和65分钟。缩短手术时间可带来更好的功能治疗效果。安装逆行髓内针时手术时间的缩短归因于这类内固定器更容易的安装技术以及微创方法的使用。在手术干预后的患者中，两组均检测到并发症。两组并发症的性质和发生率大致相同。骨固定组术后早期有4例（9.3%）患者发生感染性并发症，髓内固定组有4例（8.6%）。所有病例均为皮肤及皮下脂肪层内的术后伤口浅表感染。在骨固定组，长期有2例（4.6%）患者被诊断为股骨固定区域深部感染，需要再次手术干预。髓内固定组未记录到深部感染病例。在接受骨固定的患者组中，35例（81.4%）患者检测到I度膝关节骨关节炎，8例（18.6%）在随访3.5年后出现II度骨关节炎形成。在采用髓内固定的患者组中，36例（78.2%）患者检测到I度关节病，10例（21.8%）患者为II度。术后3.5年，所有患者均无需进行膝关节置换。股骨髁骨折的逆行髓内固定技术在长期显示出最佳的功能指标。
