外侧锁定钢板治疗股骨髁上远端骨折不愈合的技术因素：风险分层分析

Technical Factors Contributing to Nonunion in Supracondylar Distal Femur Fractures Treated With Lateral Locked Plating: A Risk-Stratified Analysis.

作者信息

Stockton David J, O'Hara Nathan N, Brodke Dane J, McKibben Natasha, Healey Kathleen, Goch Abraham, Demyanovich Haley, Devana Sai, Hernandez Adolfo, Burke Cynthia E, Gupta Jayesh, Marchand Lucas S, Dekeyser Graham J, Steffenson Lillia, Shymon Stephen J, Fairres Marshall J, Perdue Paul W, Barber Colby, Atassi Omar H, Mitchell Thomas W, Working Zachary M, Black Loren O, El Naga Ashraf N, Roddy Erika, Hogue Matthew, Gulbrandsen Trevor, Morellato John, Gillon W Hunter, Walters Murphy M, Hempen Eric, Slobogean Gerard P, Lee Christopher, O'Toole Robert V

机构信息

Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.

Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA.

出版信息

J Orthop Trauma. 2024 Jan 1;38(1):49-55. doi: 10.1097/BOT.0000000000002680.

DOI:10.1097/BOT.0000000000002680

PMID:37559208

Abstract

OBJECTIVE

To identify technical factors associated with nonunion after operative treatment with lateral locked plating.

DESIGN

Retrospective cohort study.

SETTING

Ten Level I trauma centers.

PATIENT SELECTION CRITERIA

Adult patients with supracondylar distal femur fractures (OTA/AO type 33A or C) treated with lateral locked plating from 2010 through 2019.

OUTCOME MEASURES AND COMPARISONS

Surgery for nonunion stratified by risk for nonunion.

RESULTS

The cohort included 615 patients with supracondylar distal femur fractures. The median patient age was 61 years old (interquartile range: 46 -72years) and 375 (61%) were female. Observed were nonunion rates of 2% in a low risk of nonunion group (n = 129), 4% in a medium-risk group (n = 333), and 14% in a high-risk group (n = 153). Varus malreduction with an anatomic lateral distal femoral angle greater than 84 degrees, was associated with double the odds of nonunion compared to those without such varus [odds ratio, 2.1; 95% confidence interval (CI), 1.1-4.2; P = 0.03]. Malreduction by medial translation of the articular block increased the odds of nonunion, with 30% increased odds per 4 mm of medial translation (95% CI, 1.0-1.6; P = 0.03). Working length increased the odds of nonunion in the medium risk group, with an 18% increase in nonunion per 10-mm increase in working length (95% CI, 1.0-1.4; P = 0.01). Increased proximal screw density was protective against nonunion (odds ratio, 0.71; 95% CI, 0.53-0.92; P = 0.02) but yielded lower mRUST scores with each 0.1 increase in screw density associated with a 0.4-point lower mRUST (95% CI, -0.55 to -0.15; P < 0.001). Lateral plate length and type of plate material were not associated with nonunion. ( P > 0.05).

CONCLUSIONS

Malreduction is a surgeon-controlled variable associated with nonunion after lateral locked plating of supracondylar distal femur fractures. Longer working lengths were associated with nonunion, suggesting that bridge plating may be less likely to succeed for longer fractures.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

确定外侧锁定钢板手术治疗后与骨不连相关的技术因素。

设计

回顾性队列研究。

地点

10家一级创伤中心。

患者选择标准

2010年至2019年接受外侧锁定钢板治疗的成人股骨远端髁上骨折（OTA/AO 33A或C型）患者。

观察指标及比较

根据骨不连风险对骨不连手术进行分层。

结果

该队列包括615例股骨远端髁上骨折患者。患者年龄中位数为61岁（四分位间距：46 - 72岁），女性375例（61%）。骨不连低风险组（n = 129）的骨不连发生率为2%，中风险组（n = 333）为4%，高风险组（n = 153）为14%。与无内翻畸形者相比，解剖学外侧远端股骨角大于84度的内翻畸形愈合不良使骨不连几率增加一倍[比值比，2.1；95%置信区间（CI），1.1 - 4.2；P = 0.03]。关节块向内侧移位导致的复位不良增加了骨不连几率，每向内侧移位4 mm骨不连几率增加30%（95% CI，1.0 - 1.6；P = 0.03）。在中风险组中，工作长度增加了骨不连几率，工作长度每增加10 mm骨不连增加18%（95% CI，1.0 - 1.4；P = 0.01）。近端螺钉密度增加可预防骨不连（比值比，0.71；95% CI，0.53 - 0.92；P = 0.02），但螺钉密度每增加0.1，mRUST评分降低0.4分（95% CI, -0.55至-0.15；P < 0.001）。外侧钢板长度和钢板材料类型与骨不连无关（P > 0.05）。