Lim Eic Ju, Cho Jae-Woo, Shon Oog-Jin, Oh Jong-Keon, Hwang Kyu Tae, Lee Gwang Chul
Department of Orthopaedic Surgery, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea.
J Orthop Sci. 2025 Mar;30(2):372-378. doi: 10.1016/j.jos.2024.03.007. Epub 2024 Apr 4.
The stiffness of locked plates suppresses healing process, prompting the introduction of far cortical locking to address this issue. This study aimed to demonstrate the clinical efficacy of far cortical locking constructs in treating distal femoral fractures in an Asian population.
This multicenter prospective observational study was conducted at four university hospitals between February 2018 and February 2021. Demographic data, the presence of metaphyseal comminution, and surgical fixation details were recorded. Clinical outcomes, including single-leg standing, EQ-5D, and EQ-VAS scores, and radiologic outcomes, including the RUST score of each cortex, were evaluated and compared according to the presence of metaphyseal comminution.
There were 37 patients (14 men and 23 women) with a mean age of 67.3 ± 11.8 years. Twenty-two patients had metaphyseal comminution (59%), and 15 presented simple fractures in metaphyseal areas. Four patients (13%) could stand on one leg >10s at 6 weeks, and 24 patients (92%) at 1 year. EQ-5D increased from 0.022 ± 0.388 to 0.692 ± 0.347, and the mean EQ-VAS 51.1 ± 13.1 to 74.1 ± 24.1 between discharge (n = 37) and post-operative 1 year (n = 33), respectively. RUST score presented increment for time, from 6.2 ± 1.8 at 6 week to 11.6 ± 1.1 at 1 year. Radiological healing demonstrated rapid increase from week 6 (16/28, 43%) to month 3 (27/31, 87%), with no obvious increase was observed in 6 months (23/26, 89%) or 12 months (25/28, 89%). Simple metaphyseal fractures presented significantly higher RUST scores at 6 weeks and 3 months, but there was no difference in RUST scores at 6 months or 1 year according to metaphyseal comminution.
Plate constructs with far cortical locking screws provided safe and effective fixation for distal femoral fractures, with consistent radiological and clinical results, regardless of metaphyseal comminution.
锁定钢板的刚度会抑制愈合过程，促使引入远皮质锁定以解决这一问题。本研究旨在证明远皮质锁定结构在治疗亚洲人群股骨远端骨折中的临床疗效。
本多中心前瞻性观察研究于2018年2月至2021年2月在四家大学医院进行。记录人口统计学数据、干骺端粉碎情况及手术固定细节。根据干骺端粉碎情况，评估并比较临床结果（包括单腿站立、EQ-5D和EQ-VAS评分）及放射学结果（包括各皮质的RUST评分）。
共37例患者（14例男性，23例女性），平均年龄67.3±11.8岁。22例患者存在干骺端粉碎（59%），15例为干骺端单纯骨折。4例患者（13%）在6周时能单腿站立>10秒，24例患者（92%）在1年时能单腿站立。EQ-5D从出院时（n = 37）的0.022±0.388增至术后1年（n = 33）的0.692±0.347，平均EQ-VAS分别从51.1±13.1增至74.1±24.1。RUST评分随时间增加，从6周时的6.2±1.8增至1年时的11.6±1.1。放射学愈合从第6周（16/28，43%）到第3个月（27/31，87%）迅速增加，6个月（23/26，89%）和12个月（25/28，89%）时无明显增加。干骺端单纯骨折在6周和3个月时的RUST评分显著更高，但根据干骺端粉碎情况，6个月或1年时的RUST评分无差异。
带有远皮质锁定螺钉的钢板结构为股骨远端骨折提供了安全有效的固定，无论干骺端是否粉碎，放射学和临床结果均一致。
