德国和瑞士治疗股骨远端骨折的现行标准。
Current standard of care for distal femur fractures in Germany and Switzerland.
机构信息
Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany.
出版信息
Injury. 2023 Oct;54(10):110936. doi: 10.1016/j.injury.2023.110936. Epub 2023 Jul 17.
BACKGROUND
Distal femur fractures occur with an incidence of 4.5/100,000 and show a prevalence of 0.4%. Causes include low-impact trauma in older patients and high-impact trauma in younger patients without pre-existing medical conditions. The aim of this study was to perform a comprehensive evaluation of trauma mechanisms, trauma-promoting factors, comorbidities, medication history and type of surgical care to provide an overview of the causes of injury and the most appropriate therapeutic approach.
METHODS
In this multicenter cohort study a retrospective analysis of 229 patients who sustained a distal femur fracture between January 2011 and December 2020 was performed. Individual fracture patterns, fracture predisposing factors, concomitant disease profiles, medication history, treatment strategy and associated complications were analyzed.
RESULTS
229 patients were included in the retrospective analysis. A total of 113-type 33 A, 50-type 33 B and 66-type 33 C fractures were diagnosed, of whom 92% received a lateral locking plate osteosynthesis. There was a complication in 14.4% of all cases, of which 6.1% were attributable to infection. Significant risk factors for developing a complication were an increased BMI (29.9 ± 8.5 kg/m2; p = 0.04), fracture displacement of over half a shaft width (p < 0.001) and AOC fractures (p < 0,016), specifically C2 fractures (p < 0,008).
CONCLUSION
In this multicenter retrospective cohort study, lateral locking plate osteosynthesis was the method of choice and was selected in over 90% of cases, regardless of the fracture classification and risk factors. A complication rate of 14.4% emphasizes the necessary analysis of patient- and care-specific risk factors and a resulting adjustment of the therapy strategy. An increased BMI (29.9 ± 8.5 kg/m; p = 0.04), fracture displacement of over half a shaft width (p < 0.001) and AOC fractures (p < 0,016), specifically C2 fractures (p < 0,008) increase the risk of developing a complication and should prompt an early switch to a treatment strategy that provides more stability.
背景
股骨远端骨折的发病率为 4.5/100000，患病率为 0.4%。其病因包括老年患者低能量创伤和年轻患者无预先存在的医疗条件的高能量创伤。本研究的目的是对创伤机制、促发因素、合并症、用药史和手术治疗类型进行全面评估，为损伤原因和最合适的治疗方法提供概述。
方法
在这项多中心队列研究中，对 2011 年 1 月至 2020 年 12 月期间发生股骨远端骨折的 229 名患者进行了回顾性分析。分析了个体骨折模式、骨折易患因素、并存疾病谱、用药史、治疗策略和相关并发症。
结果
229 名患者纳入回顾性分析。共诊断 113 型 33A、50 型 33B 和 66 型 33C 骨折，其中 92%接受外侧锁定钢板内固定。所有病例中并发症发生率为 14.4%，其中 6.1%归因于感染。发生并发症的显著危险因素包括 BMI 增加（29.9±8.5kg/m2；p=0.04）、骨折半干骺端移位超过一半（p<0.001）和 AOC 骨折（p<0.016），特别是 C2 骨折（p<0.008）。
结论
在这项多中心回顾性队列研究中，外侧锁定钢板内固定是首选方法，无论骨折分类和危险因素如何，都有超过 90%的患者选择这种方法。14.4%的并发症发生率强调了对患者和护理特定危险因素的必要分析，并相应地调整治疗策略。BMI 增加（29.9±8.5kg/m2；p=0.04）、骨折半干骺端移位超过一半（p<0.001）和 AOC 骨折（p<0.016），特别是 C2 骨折（p<0.008）增加了并发症发生的风险，应促使尽早转换为提供更高稳定性的治疗策略。
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