Barzen S, Buschbeck S, Hoffmann R
Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Unfallchirurgie und orthopädische Chirurgie, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland.
Unfallchirurgie (Heidelb). 2022 Jul;125(7):507-517. doi: 10.1007/s00113-022-01197-6. Epub 2022 Jun 20.
Fractures of the distal femur represent rare but serious injuries with a high 1‑year mortality. An increasingly older patient population requires adapted treatment concepts.
Surgical treatment using angular stable plating and retrograde nailing is the standard procedure. Conservative treatment is only indicated in cases of low demands and high perioperative risks of the patient.
Primary double plate osteosynthesis and primary implantation of a distal femoral replacement represent new treatment procedures and show promising initial results in the collective of geriatric patients.
DIAGNOSTIC WORK-UP: Conventional radiographs in 2 planes and computed tomography with multiplanar and 3D reconstructions should be performed to enable an adequate assessment of the indications and treatment planning.
Nonunion rates of plate and nail osteosyntheses range from 4% to 10%. No significant differences in long-term results can be observed. The results regarding double plate osteosynthesis and distal femoral replacement so far do not show any disadvantages compared to the existing procedures but there is still insufficient data for general recommendations.
Complex fractures with extensive reconstructive procedures and treatment by distal femoral replacement should be performed in specialized centers.
The gold standard is still surgical treatment by means of minimally invasive angular stable plate or retrograde nail osteosynthesis. Complex fracture forms require individual treatment planning considering all currently available treatment options.
股骨远端骨折虽罕见但伤势严重，1 年死亡率较高。患者年龄日益增大，需要适配的治疗理念。
采用角稳定钢板和逆行髓内钉进行手术治疗是标准程序。保守治疗仅适用于对治疗要求低且患者围手术期风险高的情况。
初次双钢板接骨术和初次植入股骨远端假体是新的治疗方法，在老年患者群体中初步结果良好。
应进行双平面常规 X 线片以及具有多平面和三维重建的计算机断层扫描，以便充分评估适应证和制定治疗计划。
钢板和髓内钉接骨术的骨不连发生率为 4%至 10%。长期结果未见显著差异。目前，双钢板接骨术和股骨远端假体置换术的结果与现有手术方法相比未显示出任何劣势，但仍缺乏足够数据给出一般性建议。
复杂骨折以及需要广泛重建手术和股骨远端假体置换治疗的情况应在专业中心进行。
金标准仍然是通过微创角稳定钢板或逆行髓内钉接骨术进行手术治疗。复杂骨折类型需要考虑所有现有治疗选择进行个体化治疗规划。
