Kuwahara Yutaro, Takegami Yasuhiko, Tokutake Katsuhiro, Yamada Yotaro, Komaki Kentaro, Ichikawa Tsunenobu, Imagama Shiro
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Trauma of Limbs, Nagoya Univeristy of Graduate Medicine, Nagoya, Japan.
Bone Jt Open. 2022 Feb;3(2):165-172. doi: 10.1302/2633-1462.32.BJO-2021-0191.R1.
Postoperative malalignment of the femur is one of the main complications in distal femur fractures. Few papers have investigated the impact of intraoperative malalignment on postoperative function and bone healing outcomes. The aim of this study was to investigate how intraoperative fracture malalignment affects postoperative bone healing and functional outcomes.
In total, 140 patients were retrospectively identified from data obtained from a database of hospitals participating in a trauma research group. We divided them into two groups according to coronal plane malalignment of more than 5°: 108 had satisfactory fracture alignment (< 5°, group S), and 32 had unsatisfactory alignment (> 5°, group U). Patient characteristics and injury-related factors were recorded. We compared the rates of nonunion, implant failure, and reoperation as healing outcomes and Knee Society Score (KSS) at three, six, and 12 months as functional outcomes. We also performed a sub-analysis to assess the effect of fracture malalignment by plates and nails on postoperative outcomes.
The rates of nonunion and reoperation in group U were worse than those in group S (25.0% vs 14.3%; 15.6% vs 5.6%), but the differences were not significant (p = 0.180 and p = 0.126, respectively). Mean KSS in group U at all follow-up periods was significantly worse that in group S (75.7 (SD 18.8) vs 86.0 (SD 8.7); p < 0.001; 78.9 (SD 17.2) vs 89.1 (SD 9.8); p < 0.001; 85.0 (SD 11.9) vs 91.1 (SD 7.2); p = 0.002, respectively). In the sub-analysis of plates, mean KSS was significantly worse in group U at three and six months. In the sub-analysis of nails, the rate of reoperation was significantly higher in group U (28.6% vs 5.8%; p = 0.025), and mean KSS at six and 12 months was significantly worse in Group U.
To obtain good postoperative functional results, intraoperative alignment of the coronal plane should be accurately restored to less than 5°. Cite this article: 2022;3(2):165-172.
股骨术后畸形是股骨远端骨折的主要并发症之一。很少有论文研究术中畸形对术后功能和骨愈合结果的影响。本研究的目的是探讨术中骨折畸形如何影响术后骨愈合和功能结果。
从参与创伤研究组的医院数据库中获取的数据中，回顾性确定了140例患者。我们根据冠状面畸形超过5°将他们分为两组：108例骨折对线满意（<5°，S组），32例对线不满意（>5°，U组）。记录患者特征和损伤相关因素。我们比较了不愈合、植入物失败和再次手术的发生率作为愈合结果，以及在3个月、6个月和12个月时的膝关节协会评分（KSS）作为功能结果。我们还进行了亚分析，以评估钢板和髓内钉导致的骨折畸形对术后结果的影响。
U组不愈合和再次手术的发生率比S组差（25.0%对14.3%；15.6%对5.6%），但差异不显著（分别为p = 0.180和p = 0.126）。在所有随访期，U组的平均KSS均显著低于S组（75.7（标准差18.8）对86.0（标准差8.7）；p < 0.001；78.9（标准差17.2）对89.1（标准差9.8）；p < 0.001；85.0（标准差11.9）对91.1（标准差7.2）；p = 0.002）。在钢板的亚分析中，U组在3个月和6个月时的平均KSS显著更差。在髓内钉的亚分析中，U组再次手术的发生率显著更高（28.6%对5.8%；p = 0.025），且U组在6个月和12个月时的平均KSS显著更差。
为了获得良好的术后功能结果，术中应将冠状面的对线准确恢复至小于5°。引用本文：2022；3(2):165 - 172。
