锁定加压钢板固定治疗老年股骨远端假体周围骨折的效果分析
Locking compression plating for treatment of periprosthetic distal femur fractures in the aged
刘雅克 1周振宇 1陶然 1曹毅 1朱建炜 1王友华 1陆跃 1徐华 1徐嘉诚 1马洪冬 1沈冀宁 1赵丰翔 1吴可凡 1刘璠1
作者信息
- 1. 南通大学附属医院骨科,南通 226001
- 折叠
摘要
目的 探讨锁定加压钢板(LCP)固定治疗老年股骨远端假体周围骨折(PPF)的临床效果.方法 回顾性分析2012年6月至2023年5月期间南通大学附属医院骨科采用LCP固定治疗的31例老年股骨远端PPF患者资料.男4例,女27例;年龄(80.2±6.1)岁;按PPF通用分型系统(UCS)分型:人工全膝关节置换术后Ⅴ.3B1型18例,Ⅴ.3B2型6例;髋关节置换术后Ⅳ.3C型7例.内固定方式:股骨外侧单钢板固定25例,内外侧双钢板固定6例.记录患者的手术时间、术中出血量、住院时间、术后下地负重时间、骨折愈合时间、膝关节功能及随访期间并发症发生情况等.结果 25例单钢板固定患者的手术时间为(58.7±7.9)min,术中出血量为(78.0±15.1)mL,住院时间为(6.9±1.6)d,术后下地负重时间为(5.9±1.4)d,随访时间为37(15,51)个月;6例双钢板固定患者分别为(186.6±9.8)min、(1 256.7±231.2)mL、(17.8±3.3)d、(3.6±0.6)d、17(16,21)个月.单钢板和双钢板固定患者的骨折愈合时间分别为(14.9±2.0)、(18.7±2.6)周.末次随访时根据美国特种外科医院评分标准评定膝关节功能:25例单钢板固定患者中,优10例,良15例;6例双钢板固定患者均为良.随访期间无一例患者发生切口感染、骨折不愈合及内固定失效等并发症.结论 LCP固定治疗老年股骨远端PPF可获得满意疗效.股骨外侧单钢板固定适用于大部分老年股骨远端PPF患者,可作为首选.双钢板固定可提供更坚强的稳定性,但应严格掌握其适应证.
Abstract
Objective To explore the clinical outcomes of locking compression plating(LCP)in the treatment of periprosthetic fracture(PPF)of the distal femur in the aged patients.Methods A retrospec-tive study was performed to analyze the 31 aged patients who had been treated at Department of Orthopedic Surgery,The Affiliated Hospital to Nantong University for PPF of the distal femur with LCP between June 2012 and May 2023.There were 27 females and 4 males with an age of(80.2±6.1)years.According to the Uni-fied Classification System(UCS),18 PPFs were classified as type Ⅴ.3B1 and 6 PPFs as type Ⅴ.3B2 after to-tal knee arthroplasty and 7 PPFs as type Ⅳ.3C after total hip arthroplasty.The patients were fixated with a lat-eral single plate in 25 cases,and with lateral and medial dual plates in 6 cases.The surgical time,intraopera-tive blood loss,hospitalization time,postoperative weight-bearing time,fracture healing time,and knee joint function and complications during follow-up were recorded.Results For the 25 patients undergoing fixa-tion with a lateral single plate,the surgical time was(58.7±7.9)minutes,the intraoperative blood loss(78.0±15.1)mL,the hospitalization time(6.9±1.6)days,the postoperative weight-bearing time(5.9±1.4)days,and the follow-up time 37(15,51)months.For the 6 patients undergoing fixation with lateral and medial dual plates,the surgical time was(186.6±9.8)minutes,the intraoperative blood loss(1,256.7±231.2)mL,the hospitalization time(17.8±3.3)days,the postoperative weight-bearing time(3.6±0.6)days,and the follow-up time 17(16,21)months.The fracture healing time was(14.9±2.0)and(18.7±2.6)weeks,respectively,for patients fixed with single and double steel plates.By the scoring criteria of the American Hospital for Special Surgery(HSS),the knee joint function was evaluated at the last follow-up as excellent in 10 cases and as good in 15 cases for the 25 patients undergoing fixation with a lateral single plate,and as good for all the 6 patients undergoing fixation with lateral and medial dual plates.No patient experienced such complications as incision infection,bone nonunion,or internal fixation failure during the follow-up period.Conclusions LCP fixation can achieve satisfactory outcomes in the treatment of PPF of the distal femur in the aged patients.As fixation with a single lateral femoral plate is suitable for most of the aged patients with PPF of the distal femur,it can be used as the first choice.Fixation with dual plates can pro-vide stronger stability,but its indications should be strictly controlled.
关键词
股骨骨折/骨折固定术,内/骨板/关节成形术,置换/锁定加压钢板Key words
Femoral fractures/Fracture fixation,internal/Bone plates/Arthroplasty,re-placement/Locking compression plates引用本文复制引用
出版年
2024
NETL
NSTL
万方数据