背景:锁定板的刚度抑制了愈合过程,提示引入远皮质锁定来解决这个问题。本研究旨在证明远皮质锁定结构治疗亚洲人群股骨远端骨折的临床疗效。
方法:这项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。人口统计数据,干phy端粉碎的存在,并记录手术固定细节.临床结果,包括单腿站立,EQ-5D,和EQ-VAS分数,和放射学结果,包括每个大脑皮层的RUST评分,根据干phy端粉碎的存在进行评估和比较。
结果:有37名患者(14名男性和23名女性),平均年龄为67.3±11.8岁。22例患者有干phy端粉碎(59%),15例出现干phy端区域的单纯骨折。四名患者(13%)在6周时可以站在一条腿上>10秒,和24名患者(92%)在1年。EQ-5D从0.022±0.388增加到0.692±0.347,出院(n=37)和术后1年(n=33)之间的平均EQ-VAS为51.1±13.1至74.1±24.1,分别。RUST分数呈现时间增量,从6周时的6.2±1.8到1年时的11.6±1.1。放射学愈合显示从第6周(16/28,43%)到第3个月(27/31,87%)迅速增加,6个月(23/26,89%)或12个月(25/28,89%)无明显升高。在6周和3个月时,单纯性干phy端骨折的RUST评分明显较高。但在6个月或1年的RUST评分根据干phy端粉碎没有差异。
结论:带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,具有一致的放射学和临床结果,不管干phy端粉碎。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.