钢板联合骨折端螺钉固定老年股骨远端骨折的疗效观察

Effectiveness of locking plate and interfragmentary screw for distal femoral fractures in the elderly

目的探讨“钢板联合骨折端螺钉”与“单纯钉板系统”固定老年股骨远端骨折的临床疗效。方法回顾性分析2017年6月至2021年6月上海市浦东新区人民医院治疗且获随访的40例简单老年股骨远端骨折的患者资料。其中,20例采用“钢板联合骨折端螺钉”固定(联合组),平均年龄(70.8±5.6)岁,骨密度T值平均-1.91±0.56;20例采用“单纯钉板系统”固定(单纯组),平均年龄(69.9±6.0)岁,骨密度T值平均-1.88±0.60。比较两组患者的手术时间、术中出血量、骨痂形成时间、影像学愈合时间、术后并发症及术后3、6、12个月Neer评分。结果40例患者随访12~36个月,平均(17.3±5.6)个月。联合组患者手术时间明显少于单纯组,差异有统计学意义(P<0.05);两组患者术中出血量比较,差异无统计学意义(P>0.05)。两组患者的骨痂形成时间比较,差异无统计学意义(P>0.05);但联合组患者影像学愈合时间明显少于单纯组,差异有统计学意义(P<0.05)。单纯组出现2例骨折畸形愈合,而联合组无此类并发症发生,但两组并发症发生率比较,差异无统计学意义(P>0.05)。术后3、6、12个月随访时,联合组Neer评分分别为(72.90±3.81)分、(81.45±5.68)分、(87.35±3.72)分,单纯组分别为(70.50±4.34)分、(80.35±4.68)分、(86.70±3.28)分,两组比较差异均无统计学意义(P>0.05)。结论与“单纯钉板系统”固定相比,“钢板联合骨折端螺钉”固定老年股骨远端骨折能降低手术时间及促进骨折早期愈合。

Objective To explore the effectiveness of locking plate with or without interfragmentary screw for distal femoral fractures in the elderly.Methods From June 2017 to June 2021,40 elderly patients with simple distal femoral fractures in Shanghai Pudong New Area People's Hospital were analyzed.Combined group included 20 patients who were treated with locking plate and interfragmentary screw,with an average age of(70.8±5.6)years,and the T value of bone mineral density(BMD)was-1.91±0.56.The simple group included 20 patients who were fixed with locking plate only undergoing traditional closed reduction technique,with an average age of(69.9±6.0)years,and the T value of BMD was-1.88±0.60.A retrospective study was performed to compare the results of operation time,intraoperative blood loss,initial callus formation time,radiographic healing time,postoperative complications and Neer scores at 3,6 and 12 months after operation.Results All patients were followed up from 12 to 36 months,with an average of(17.3±5.6)months.The operation time in the combined group was significantly shorter than that in the simple group(P<0.05).The intraoperative blood loss showed no significant difference between the two groups(P>0.05).There was no significant difference in initial callus formation time between the two groups(P>0.05).The radiographic time in the combined group was significantly less than that in the simple group(P<0.05).There were 2 cases of malunion in the simple group,and no malunion or nonunion occurred in the combined group,with no significant difference in the incidence of complications between the two groups(P>0.05).The Neer scores of the combined group were 72.90±3.81,81.45±5.68 and 87.35±3.72 at 3,6 and 12 months after operation,while those of the simple group were 70.50±4.34,80.35±4.68,and 86.70±3.28,respectively,with no significant difference(P>0.05).Conclusion Locking plate combined with interfragmentary screw can reduce the operation time and facilitate early fracture healing,it is conducive to achieve good results for distal femoral fractures in the elderly.