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仅采用腓骨异体骨移植和外侧钢板固定治疗老年人群股骨远端骨折：手术技术

Distal femur fractures in the elderly population treated with fibular allograft and lateral plating only: the surgical technique.

作者信息

Morello Vanessa, Berry Gregory, Bernstein Mitchell, Bunting Alexandra, Harvey Edward, Reindl Rudolf

机构信息

Division of Orthopaedic and Trauma Surgery, MUCH, McGill University Health Center, Montreal General Hospital, Montreal, QC, Canada.

出版信息

OTA Int. 2025 Aug 1;8(3):e416. doi: 10.1097/OI9.0000000000000416. eCollection 2025 Sep.

DOI:10.1097/OI9.0000000000000416
PMID:40755550
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12316342/
Abstract

Distal femoral fractures are increasingly observed in the elderly population, often presenting with osteoporotic bone characteristics. Surgical fixation remains the gold standard, with lateral locking plates being the most commonly used method. To prevent hardware failure and varus collapse in osteoporotic bone, various surgical techniques and augmentation strategies have been proposed. We describe a surgical technique for managing osteoporotic, comminuted distal femur fractures using a fibular strut allograft in combination with a lateral-only locking plate, along with outcomes in patients treated with this approach. When an intra-articular component was present, it was addressed first. Through the zone of comminution and a cortical window created in the lateral condyle, a fibular strut allograft was inserted into the femoral canal extending into the epiphysis. Once satisfactory alignment and reduction were confirmed radiographically, a lateral locking plate was applied, bridging any existing proximal implants. Proximal screws were inserted percutaneously, while multiple screws were directed through the fibular graft for enhanced stability. The combination of a fibular strut allograft with a lateral locking plate offers a reliable option for treating comminuted distal femur fractures with osteoporotic features, minimizing displacement and reducing the risk of implant failure without necessitating additional medial support or secondary implants.

摘要

股骨远端骨折在老年人群中越来越常见，常表现出骨质疏松性骨的特征。手术固定仍然是金标准，外侧锁定钢板是最常用的方法。为防止骨质疏松性骨中内固定失败和内翻塌陷，人们提出了各种手术技术和增强策略。我们描述了一种使用腓骨支撑异体骨联合仅外侧锁定钢板治疗骨质疏松性、粉碎性股骨远端骨折的手术技术，以及采用这种方法治疗的患者的结果。当存在关节内骨折块时，首先处理该骨折块。通过粉碎区域和在外侧髁创建的皮质骨窗口，将腓骨支撑异体骨插入股骨髓腔并延伸至骨骺。一旦通过影像学确认达到满意的对线和复位，应用外侧锁定钢板，跨越任何现有的近端植入物。近端螺钉经皮插入，同时多枚螺钉穿过腓骨移植骨以增强稳定性。腓骨支撑异体骨与外侧锁定钢板的联合应用为治疗具有骨质疏松特征的粉碎性股骨远端骨折提供了一种可靠的选择，可将移位降至最低，并降低植入物失败的风险，而无需额外的内侧支撑或二次植入物。

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本文引用的文献

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Successful Plate Fixation with Long Intramedullary Fibula Bone Graft for Periprosthetic Femur Fracture: A Case Report.经皮顺行髓内钉固定联合腓骨骨段移植治疗股骨假体周围骨折：1 例报告。
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Use of an intramedullary fibular strut allograft and dual locking plate in periprosthetic fractures above total knee arthroplasty: new application of a well-known treatment method in trauma.
应用髓内腓骨支撑骨移植物和双锁定钢板治疗全膝关节置换术后假体周围骨折：创伤中一种知名治疗方法的新应用。
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Injury. 2020 Aug;51 Suppl 3:S39-S44. doi: 10.1016/j.injury.2019.10.078. Epub 2019 Oct 24.
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Single-Incision Double-Plating Approach in the Management of Isolated, Closed Osteoporotic Distal Femoral Fractures.单切口双钢板入路治疗孤立性、闭合性骨质疏松性股骨远端骨折
Geriatr Orthop Surg Rehabil. 2018 Nov 11;9:2151459318799856. doi: 10.1177/2151459318799856. eCollection 2018.
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Bone Tissue Donation: Tendency and Hurdles.骨组织捐赠：趋势与障碍
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Use of Nonvascularized Autologous Fibular Strut Graft in the Treatment of Major Bone Defect after Periprosthetic Knee Fracture.非血管化自体腓骨支撑骨移植在治疗人工膝关节周围骨折后大的骨缺损中的应用
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