Department of Orthopedics, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai, China; Hospital Affiliated to 71217, Yantai, China.
Department of Orthopedics, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai, China.
J Orthop Sci. 2023 Sep;28(5):1105-1112. doi: 10.1016/j.jos.2022.06.015. Epub 2022 Jul 19.
This study aims to compare therapeutic effects of two methods in complicated subtrochanteric femur fractures surgery: intramedullary nail fixation assisted with lateral monocortical locking plate versus intramedullary nail fixation assisted with supplementary cables.
From June 2015 to June 2020, seventy-seven patients with complex subtrochanteric fractures (i.e., Seinsheimer's classification type IV or V) were included in this study. Thirty-six patients (plate group) were operated using the intramedullary nail fixation assisted by lateral monocortical locking plate, and forty-one patients (cable group) were using the intramedullary nail fixation assisted by cables. The clinical information and demographic results were collected and compared.
Operation time of plate group was shorter than cable group and the Incisions length of plate group was longer. The fluoroscopy times were 22.8 ± 8.2 in plate group and 33.0 ± 9.0 in cable group (p < 0.01). Compared with the cable group, patients in plate group used less cerclage cables (p < 0.01). Patients in the plate group has less medial cortex displacement compared with the cable group. (p = 0.038). As for the angular difference of neck shaft angle between operated hip and uninjured hip, plate group has less difference compared with the cable group. Time to union was 14.2 ± 3.1 weeks in plate group which is shorter than the cable group (17.9 ± 4.8 weeks). In terms of follow up period, number of malunion, Harris hip score, walking ability and traumatic hip rating scale, no significant differences were detected.
Our results suggest that using lateral monocortical plate as an auxiliary way may have a longer surgical incision and more intraoperative blood loss, however, the operation time is shorter, the fluoroscopy times is less, and the time to union is shorter. Intramedullary nail fixation assisted by lateral monocortical locking plate may be a new option for patients with complex subtrochanteric femur fractures.
本研究旨在比较两种方法在复杂股骨转子下骨折手术中的治疗效果：髓内钉固定辅助外侧单皮质锁定板与髓内钉固定辅助附加钢缆。
本研究纳入 2015 年 6 月至 2020 年 6 月间 77 例复杂股骨转子下骨折患者（即 Seinsheimer 分类 IV 或 V 型）。36 例患者（钢板组）采用髓内钉固定辅助外侧单皮质锁定板治疗，41 例患者（钢缆组）采用髓内钉固定辅助钢缆治疗。收集并比较了临床资料和人口统计学结果。
钢板组的手术时间短于钢缆组，钢板组的切口长度长于钢缆组。钢板组的透视次数为 22.8±8.2 次，钢缆组为 33.0±9.0 次（p<0.01）。与钢缆组相比，钢板组患者使用的环扎钢缆更少（p<0.01）。钢板组患者的内侧皮质移位小于钢缆组（p=0.038）。对于手术髋关节与未受伤髋关节颈干角的角度差异，钢板组的差异小于钢缆组。钢板组的愈合时间为 14.2±3.1 周，短于钢缆组（17.9±4.8 周）。在随访期间，畸形愈合、Harris 髋关节评分、行走能力和创伤性髋关节评分无显著差异。
我们的结果表明，使用外侧单皮质钢板作为辅助方式可能会有更长的手术切口和更多的术中失血，但手术时间更短，透视次数更少，愈合时间更短。髓内钉固定辅助外侧单皮质锁定板可能是治疗复杂股骨转子下骨折患者的一种新选择。
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