Redondo-Trasobares B, Sarasa-Roca M, Rosell-Pradas J, Calvo-Tapies J, Gracia-Villa L, Albareda-Albareda J
Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
Rev Esp Cir Ortop Traumatol. 2023 May-Jun;67(3):T216-T225. doi: 10.1016/j.recot.2023.02.025. Epub 2023 Mar 1.
Distal femoral fractures represent a problem due to their high number of complications. The aim was to compare the results, complications and stability achieved with retrograde intramedullary nailing and the angular stable plate in the treatment of distal femoral diaphyseal fractures.
A clinical and experimental biomechanical study was carried out using finite elements. The results of the simulations allowed us to obtain the main results related to the stability of osteosynthesis. For clinical follow-up data, frequencies were used for qualitative variables, and Fisher's exact test and χ test were used to evaluate the significance of the different factors, with the condition of P<.05.
In the biomechanical study, the retrograde intramedullar nails demonstrated superiority, obtaining lower values in terms of global displacement, maximum tension, torsion resistance, and bending resistance. In the clinical study, the rate of consolidation of the plates was lower than nails (77% vs. 96%, P=.02). The factor that most influenced the healing of fractures treated with plate were the central cortical thickness (P=.019). The factor that most influenced the healing of nail-treated fractures was the difference between the diameter of the medullary canal and the nail.
Our biomechanical study shows that both osteosynthesis provide sufficient stability, but biomechanically behaves differently. Nails provide greater overall stability being preferable the use of long nails adjusted to the diameter of the canal. Plates form less rigid osteosynthesis, with little resistance to bending.
股骨远端骨折因其大量并发症而成为一个问题。目的是比较逆行髓内钉和角稳定钢板在治疗股骨远端骨干骨折时所取得的结果、并发症及稳定性。
采用有限元进行了一项临床和实验生物力学研究。模拟结果使我们能够获得与骨愈合稳定性相关的主要结果。对于临床随访数据，定性变量采用频率分析，不同因素的显著性采用Fisher精确检验和χ检验进行评估，以P<0.05为条件。
在生物力学研究中，逆行髓内钉显示出优势，在整体位移、最大张力、抗扭转和抗弯曲方面获得较低值。在临床研究中，钢板的骨愈合率低于髓内钉（77%对96%，P = 0.02）。影响钢板治疗骨折愈合的最主要因素是中央皮质厚度（P = 0.019）。影响髓内钉治疗骨折愈合的最主要因素是髓腔直径与髓内钉直径的差值。
我们的生物力学研究表明，两种内固定方法均能提供足够的稳定性，但生物力学表现不同。髓内钉提供了更高的整体稳定性，使用与髓腔直径适配的长髓内钉更为可取。钢板形成的内固定刚性较小，抗弯曲能力较弱。
