锁定钢板加拉力螺钉与不加螺钉治疗老年股骨远端骨折疗效比较

Efficacy comparison of locking plate with or without lag screw in the treatment of distal femoral fractures in the elderly

目的比较锁定钢板加拉力螺钉与不加螺钉治疗老年股骨远端骨折的临床疗效。方法将26例老年股骨远端骨折患者根据手术方法不同分为A组(采用锁定钢板加拉力螺钉治疗,13例)与B组(采用锁定钢板不加拉力螺钉治疗,13例)。记录两组手术时间、术中出血量、骨折愈合时间,比较术后1、3、6、12个月两组疼痛VAS评分、膝关节活动度及Neer评分。结果患者均获得随访,时间12~30个月。手术时间两组比较差异有统计学意义(P<0.05),术中出血量、骨折愈合时间两组比较差异均无统计学意义(P>0.05)。术后1、3、6、12个月,VAS评分、膝关节活动度及Neer评分两组比较差异均无统计学意义(P>0.05)。B组1例出现股骨旋转不良。两组均无感染、下肢深静脉血栓形成、螺钉松动或钢板断裂等并发症发生,未出现明显膝关节僵硬。结论锁定钢板加拉力螺钉治疗老年股骨远端骨折可以缩短手术时间,减小骨折间隙,利于骨折早期愈合。

Objective To compare clinical effect of locking plate with or without lag screw in the treatment of distal femoral fractures in the elderly.Methods Twenty-six elderly patients of distal femoral fractures were divided into two groups,of which 13 patients were treated with locking plate combined with lag screw(group A)and 13 cases were treated with sole locking plate without lag screw(group B).The operation time,intraoperative blood loss,fracture healing time,postoperative 1-month,3-month,6-month and 12-month visual analogue score(VAS),knee range of motion(ROM),and knee Neer score were compared between the two groups.Results All patients were followed up for 12~30 months.There was significant difference in operation time between the two groups(P<0.05).However,there were no statistically significant differences in intraoperative blood loss and fracture healing time(P>0.05).Postoperative 1-month,3-month,6-month and 12-month VAS,knee ROM of injured extremity and knee Neer score showed no statistical significances(P>0.05).One case of malrotation developed in group B.No infection,deep venous thrombosis,lag screw loosening or plate rupture was found in either group.No patient had obvious knee stiffness.Conclusions Locking plate combined with lag screw for distal femoral fractures in elderly patients can reduce the operation time,lessen fracture gap and facilitate early fracture healing.