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股骨远端关节内骨折的钢板固定:功能和影像学结果

Plating for Intra-articular Fractures of the Distal Femur: Functional and Radiological Outcomes.

作者信息

Bandaru Hrushikesh, Shanthappa Arun H

机构信息

Orthopaedics, Sri Devraj Urs Medical College, Kolar, IND.

出版信息

Cureus. 2023 Jan 1;15(1):e33207. doi: 10.7759/cureus.33207. eCollection 2023 Jan.

DOI:10.7759/cureus.33207
PMID:36733563
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9887661/
Abstract

Background and objective Intra-articular fractures of the distal femur pose a significant surgical difficulty. These fractures are challenging to repair, and surgery is frequently advised for a successful outcome. The distal femoral fractures make up between 4-6% of all femoral fractures and account for less than 1% of all fractures. When compared to the single screw's axial stiffness or pullout resistance, as is the case with unlocked plates, the locking compression plate (LCP) is a single beam construct whose strength of fixation is equal to the sum of all screw-bone contacts. Against this backdrop, the current study was conducted for evaluating the functional outcomes of distal femoral fractures treated with LCP fixation. Methodology We conducted an observational study at a tertiary care facility in Kolar spanning a period of three years, from January 2019 to January 2022. We included all patients aged more than 18 years, who were diagnosed with distal femoral fractures [only those classified as type C according to the AO Foundation/Orthopedic Trauma Association (AO/OTA) classification]. Patients with terminal illnesses, revision of previous surgery, fractures with neurovascular injuries, and those diagnosed with pathological fractures were excluded from the study. The included patients were treated by LCP and discharged on postoperative day 10 after suture removal. The first follow-up was at the first month and subsequent follow-ups were done at three and six months, and the functional outcomes were assessed by using Neer's score for straight leg raises. Radiographs with fading fracture lines and callus formation on three-fourths of the cortices were regarded as indicators of fracture healing. Results Among the 30 study participants, 80% were males. The mean time for the radiological union was 15 weeks. In this study, there were no instances of infection or angular deformity greater than 5 degrees. About 80% of the study participants had ranges of motion (ROM) above 120 degrees at the end of the six-month follow-up period; 12 cases had an excellent score (40%), 15 cases (50%) had a satisfactory score, two cases (6.7%) had an unsatisfactory score, and only one case had poor score. Common complications observed were excessive bleeding, difficulty in reduction, superficial infections, and knee stiffness. Conclusion For patients with distal femoral fractures, the LCP treatment can result in good functional and radiological outcomes with fewer complications.

摘要

背景与目的 股骨远端关节内骨折给手术带来了很大困难。这些骨折修复具有挑战性,通常建议手术以获得成功结果。股骨远端骨折占所有股骨骨折的4%-6%,占所有骨折的不到1%。与非锁定钢板那样的单枚螺钉的轴向刚度或拔出阻力相比,锁定加压钢板(LCP)是一种单梁结构,其固定强度等于所有螺钉与骨接触的总和。在此背景下,开展了本研究以评估LCP固定治疗股骨远端骨折的功能结局。

方法 我们在科拉尔的一家三级医疗机构进行了一项为期三年的观察性研究,时间从2019年1月至2022年1月。我们纳入了所有年龄超过18岁、被诊断为股骨远端骨折的患者[仅那些根据AO基金会/骨科创伤协会(AO/OTA)分类归为C型的骨折]。患有终末期疾病、既往手术翻修、伴有神经血管损伤的骨折以及被诊断为病理性骨折的患者被排除在研究之外。纳入的患者采用LCP治疗,术后第10天拆线后出院。首次随访在第一个月进行,随后在三个月和六个月进行随访,使用Neer直腿抬高评分评估功能结局。骨折线模糊且四分之三皮质出现骨痂形成的X线片被视为骨折愈合的指标。

结果 在30名研究参与者中,80%为男性。放射学愈合的平均时间为15周。在本研究中,没有发生感染或角度畸形大于5度的情况。约80%的研究参与者在六个月随访期结束时活动范围(ROM)超过120度;12例评分优秀(40%),15例(50%)评分满意,2例(6.7%)评分不满意,只有1例评分差。观察到的常见并发症有出血过多、复位困难、浅表感染和膝关节僵硬。

结论 对于股骨远端骨折患者,LCP治疗可带来良好的功能和放射学结局,并发症较少。

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Minimally invasive plate osteosynthesis with dual plating for periprosthetic distal femoral fractures following total knee arthroplasty.全膝关节置换术后假体周围股骨远端骨折的双钢板微创接骨术。
J Orthop Surg Res. 2021 Jul 6;16(1):433. doi: 10.1186/s13018-021-02586-0.
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Clinical outcomes of treatment with locking compression plates for distal femoral fractures in a retrospective cohort.锁定加压钢板治疗股骨远端骨折的回顾性队列研究的临床结果。
J Orthop Surg Res. 2019 Nov 26;14(1):384. doi: 10.1186/s13018-019-1401-9.
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Complex AO type C3 distal femur fractures: Results after fixation with a lateral locked plate using modified swashbuckler approach.复杂AO C3型股骨远端骨折:采用改良海盗式入路外侧锁定钢板固定后的结果
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