锁定钢板治疗股骨远端粉碎性骨折的现状与进展

Current status and progress of locking plate in the treatment of distal femoral comminuted fracture

目的对锁定钢板治疗股骨远端粉碎性骨折的现状与进展进行综述。方法广泛查阅近年国内外相关文献,从锁定钢板的治疗现状、锁定钢板的不足与对策、锁定技术的进展、锁定钢板与数字骨科技术4个方面,总结锁定钢板治疗股骨远端粉碎性骨折的现状与进展。结果股骨远端粉碎性骨折治疗较为棘手,外侧锁定钢板作为股骨远端粉碎性骨折最常用固定方式,仍面临着较高治疗失败率。双钢板可改善粉碎性骨折的力学稳定性,但何时选择双钢板固定仍缺乏具体量化标准。远皮质锁定螺钉可改善骨折断端间的微动、促进骨痂生长,显示了较好的应用价值。双相钢板是对传统锁定钢板的优化,但有待临床进一步验证其效果。数字骨科技术作为一种辅助手段,显示了较好的应用前景。结论锁定钢板内在缺陷是影响股骨远端粉碎性骨折预后的因素,通过对锁定技术的优化结合数字骨科技术,有望降低股骨远端粉碎性骨折的治疗失败率。

Objective To review the current status and progress of locking plate for the treatment of distal femoral comminuted fractures. Methods The related literature was extensively reviewed to summarize the current status and progress in the treatment of distal femoral comminuted fracture with locking plate from four aspects: the current treatment situation, the shortcomings of locking plate and countermeasures, the progress of locking technology, locking plate and digital orthopedic technology. Results Treatment of distal femoral comminuted fractures is challenging.Locking plates, the most commonly used fixation for distal femoral comminuted fractures, still face a high rate of treatment failure. Double plates can improve the mechanical stability of comminuted fractures, but specific quantitative criteria are still lacking for when to choose double plates for fixation. The far cortial locking screw has shown good application value in improving the micro-movement and promoting the growth of callus. The biphasic plating is a development of the traditional locking plate, but needs further clinical examination. As an auxiliary means, digital orthopedic technology shows a good application prospect. Conclusion The inherent defect of locking plate is a factor that affects the prognosis of distal femoral comminuted fracture. The optimization of locking technology combined with digital orthopedic technology is expected to reduce the failure rate of treatment of distal femoral comminuted fracture.