PDF(Pubmed)
Abstract：
Treatment of osteoporotic distal femur fractures is often complicated by a high rate of nonunion and varus collapse. For such fractures, lateral plating with lateral incision and double plating with anterior paramedial incision have shown promising results in the recent literature. The hypothesis of this study was that bilateral plating of comminuted distal femur fractures in osteoporotic patients would result in higher union rates and lower revision rates compared to an isolated lateral locking plate. The study included 56 patients (23 males, 33 females) with supracondylar femur fracture. According to the OA/OTA classification, 9 were type A3, 8 were A2, 13 were C1, 16 were C2, and 10 were C3. The mean follow-up period was 12 months, with 29 patients treated using lateral mini-incision, lateral locking plate, and 27 patients treated with anterior paramedial incision, dual plating. The clinical and radiological results were evaluated. The mean duration of radiological union in the studied population was 15 ± 2.1 months (range, 11-21 months) in the single plate group (Group A), and 13.5 ± 2.6 months (range, 9-19 months) in the double plate group (Group B). Mean ROM was 112.3° and flexion contracture 4° in Group A, and ROM 108.3° and flexion contracture 6.7° in Group B. (P = .15). The average Western Ontario and McMaster Universities Arthritis Index (WOMAC) score was 85.6 points in Group A and 83.5 points in Group B (P = .2278). The postoperative anteversion measurement in the operated extremity ranged from -15 to 19 in Group A, and from 5 to 18 in Group B. When the anteversion degrees were compared between the injured and uninjured extremities in the postoperative period, a significant difference was observed within Group A (P = .0018), but no significant difference was observed in Group B (P = .2492). Dual plate fixation using the anterior paramedial approach is an effective operative method for osteoporotic distal femur fractures. This has many advantages such as precise exposure, easy manipulation, anatomic reduction, and stable fixation. However, for surgical indications and medial bone defects > 1 cm, grafting should be performed.
摘要：
骨质疏松性股骨远端骨折的治疗通常因骨不连和内翻塌陷的高发生率而复杂化。对于这样的骨折，在最近的文献中，带有侧向切口的侧向钢板和带有前旁切口的双钢板显示出有希望的结果。这项研究的假设是，与孤立的外侧锁定钢板相比，骨质疏松患者股骨远端粉碎性骨折的双侧钢板将导致更高的愈合率和更低的翻修率。该研究包括56名患者(23名男性，33名女性）合并股骨髁上骨折。根据OA/OTA分类，9是A3型，8是A2型，13是C1型，16是C2型，10是C3型。平均随访时间为12个月,29例患者使用外侧小切口治疗，侧向锁定板,和27例接受前辅助切口治疗的患者，双电镀。评估临床和放射学结果。研究人群放射学联合的平均持续时间为15±2.1个月(范围，11-21个月）在单板组（A组）中，和13.5±2.6个月(范围，9-19个月）在双板组（B组）中。A组平均ROM为112.3°，屈曲挛缩为4°，B组ROM108.3°和屈曲挛缩6.7°（P=.15）。A组的西安大略省和麦克马斯特大学关节炎指数（WOMAC）平均得分为85.6分，B组为83.5分（P=0.2278）。A组手术肢体术后前倾测量范围为-15～19，B组从5到18，当在术后期间比较受伤和未受伤四肢的前倾程度时，在A组中观察到显着差异（P=0.0018），但B组无显著差异(P=.2492)。采用前路辅助入路的双钢板固定是治疗骨质疏松性股骨远端骨折的有效手术方法。这具有许多优点，例如精确曝光，易于操作，解剖还原,稳定的固定。然而,对于手术指征和内侧骨缺损>1厘米，应该进行嫁接。
