目的:分析外侧锁定钢板(LLP)治疗股骨远端骨折后因骨不连或内固定失败而需要翻修手术的相关因素。
方法:回顾性分析我院2005年3月至2019年3月收治的130例股骨远端骨折患者的临床资料。采用SPSS17.0软件(单因素分析和Logistic回归分析)分析一般情况[性别,年龄,体重指数(BMI),合并症,吸烟史],损伤相关因素(损伤能量,开放性或闭合性损伤,骨折的AO/OTA分类,断裂面积分布),手术相关因素(手术时间,还原质量,术后感染)和内固定的构造特征。
结果:纳入研究的130例患者中有12例接受了修正性手术,修订率为9.2%。单因素分析显示年龄差异显著,BMI,AO/OTA分类,断裂面积分布,操作时间,还原质量,钢板长度/断裂区域,两组髁突以上钢板/骨折区长度比较(P<0.05)。Logistic回归分析显示AO/OTA分类(A3),髁上受累骨折,操作时间,复位质量和髁上钢板/骨折区长度是可能的相关因素(P<0.05)。粉碎性A3型骨折股骨内侧支撑能力的破坏,髁上皮质区骨折受累,由于断裂复位质量差,LLP的弯曲应力增加,由于长时间手术导致骨折端血液供应受损,钢板长度不足引起的应力集中可能是LLP治疗股骨远端骨折后改良手术的危险因素。对于LLP治疗后需要翻修的患者,额外使用内侧微创钢板固定和自体骨移植,改变髓内钉固定是临床常用的治疗策略。
结论:AO/OTA分类(A3),髁上受累骨折,操作时间长,在使用外侧锁定钢板治疗的股骨远端骨折中,复位质量差和髁上钢板/骨折区域长度是翻修的可能预测因素.锁定钢板的恰当应用和手术策略是降低股骨远端骨折翻修率的关键。
OBJECTIVE: To analyze the factors related to the need for revision surgery due to nonunion or internal fixation failure after the treatment of distal femoral fracture with
lateral locking plate (LLP).
METHODS: Retrospective analysis was made of the clinical data of 130 cases with distal femoral fracture treated in our hospital from March 2005 to March 2019. SPSS 17.0 software (univariate analysis and Logistic regression analysis) was used to analyze the general condition [gender, age, body mass index (BMI), comorbidities, smoking history], injury related factors (energy of injury, open or closed injury, AO/OTA classification of fracture, fracture area distribution), operation related factors (operation time, reduction quality, postoperative infection) and construct characteristics of internal fixation.
RESULTS: Twelve of 130 patients who were included in the study underwent revisional surgery, with a revision rate 9.2%. Univariate analysis showed that there were significant differences in age, BMI, AO/OTA classification, fracture area distribution, operation time, reduction quality, length of plate/fracture area, length of plate/fracture area above condylar between the two groups (P < 0.05). Logistic regression analysis showed that AO/OTA classification (A3), supracondylar involved fracture, operation time, reduction quality and the length of the plate/fracture area above the condylar were the possible related factors (P < 0.05). Destruction of the medial support ability of the femur in comminuted type A3 fracture, supra-condylar cortex area fracture involvement, increase of the bending stress of the LLP due to poor fracture reduction quality, damage of the blood supply of fracture end due to long-time operation, and stress concentration caused by insufficient length of plate might be risk factors of revisional operation after the treatment of distal femoral fracture with LLP. For the patients who needed revision after LLP treatment, additional use of medial minimally invasive plate fixation and autologous bone transplantation, change to intramedullary nail fixation were commonly used clinical treatment strategies.
CONCLUSIONS: AO/OTA classification (A3), supracondylar involved fracture, long operation time, poor reduction quality and the length of the plate/fracture area above the condylar were the possible predictive factors of the revision in distal femoral fractures treated with
lateral locking plate. The appropriate application of the locking plate and operation strategy are the key to reduce the revision rate in distal femoral fractures.