桥接系统两种构型固定股骨远端骨折比较△

Comparison of two configurations with bridge combined fixation system for distal femoral fractures

摘要:

[目的] 比较桥接系统（bridge combined fixation system, BCFS） 混棒固定（hybrid fixation） 与双棒固定（double-rodfixation, DRF） 治疗股骨远端骨折的临床效果。[方法] 回顾性分析2018 年1 月—2020 年12 月本院应用BCFS 固定股骨远端骨折36 例患者的临床资料。依据医患沟通结果，17 例采用HF，另外19 例采用DRF。比较两组围手术期、随访及影像资料。[结果] 两组患者均顺利完成手术，无严重并发症。HF 组的手术时间[(110.8±16.6) min vs (97.5±13.4) min, P＜0.05] 和切口长度[(22.9±4.2) cm vs (19.6±3.0) cm, P＜0.05] 显著多于DRF 组，但两组间术中出血量、透视次数、术后引流量、切口愈合等级及住院时间的差异均无统计学意义（P＞0.05）。两组随访时间均超12 个月，HF 组的下地行走时间[(31.9±9.1) d vs (40.4±9.1) d, P＜0.05]和完全负重活动时间[(117.0±32.4) d vs (149.0±44.7) d, P＜0.05] 显著早于DRF 组。随时间推移，两组患者膝ROM、HSS 评分及Schatzker-Lambert（S-L） 评级均显著增加（P＜0.05）；术前两组间上述指标的差异均无统计学意义（P＞0.05），术后相同时间点两组膝屈-伸ROM 的差异无统计学意义（P＞0.05）；术后1 个月，HF 组的HSS 评分显著优于DRF 组[(60.2±4.2) vs (56.5±5.1),P＜0.05]，但术后6 个月、末次随访时，两组差异已无统计学意义（P＞0.05）。HF 组的S-L 评级[优/良/可/差，术后6 个月(7/9/1/0) vs (3/9/5/2), P＜0.05；末次随访时(14/2/1/0) vs (9/8/1/1), P＜0.05] 显著优于DRF 组。影像方面，两组骨折复位质量、骨折愈合时间的差异无统计学意义（P＞0.05）。HF 组的FTA 角度显著小于DRF 组（P＜0.05）。[结论] 相较于双棒桥接系统，混棒式桥接系统治疗股骨远端骨折获得稳定固定的同时，可避免股骨远端内翻畸形，对于粉碎性骨折，能获得良好的临床效果。

Abstract:

[Objective] To compare the clinical outcomes of the bridge combined fixation system (BCFS) used in hybrid fixation (HF)versus double-rod fixation (DRF) for distal femoral fractures. [Methods] A retrospective study was conducted on 36 patients who receiveBCFS internal fixation for distal femoral fractures in our hospital from January 2018 to December 2020. Based on doctor-patient communi-cation, 17 patients received HF, while the other 19 patients received DRF. The perioperative period, follow-up and imaging data of the twogroups were compared. [Results] Two groups of patients successfully completed the operations with no serious complications. Although theHF group proved significantly greater than the DRF group in terms of operation time [(110.8±16.6) min vs (97.5±13.4) min, P＜0.05] and in-cision length [(22.9±4.2) cm vs (19.6±3.0) cm, P＜0.05], there were no significant differences in intraoperative blood loss, fluoroscopy times,postoperative drainage volume, incision healing grade and hospital stay between the two groups (P＞0.05). All patients in both groups werefollowed up for more than 12 months, and the HF group resumed walking [(31.9±9.1) days vs (40.4±9.1) days, P＜0.05] and the full weightbearingactivity [(117.0±32.4) days vs (149.0±44.7) days, P＜0.05] significantly earlier than the DRF group. The knee ROM, HSS scores andSchatzker-Lambert (S-L) scale significantly increased in both groups over time (P＜0.05). Despite of the fact that there were no significantdifferences in the above indexes between the two groups before surgery (P＞0.05), and no significant differences in knee flexion-extensionROM between the two groups at any matching time point after surgery (P＞0.05), the HF group proved significantly superior to the DRFgroup in term of HSS score one month after surgery [(60.2±4.2) vs (56.5±5.1), P＜0.05], whereas which became not statistically significantbetween the two groups at 6 months after surgery and the latest follow-up (P＞0.05). In addition, the former was significantly better than the latter in term of S-L grade [excellent/good/fair/poor, 6 months postoperatively (7/9/1/0) vs (3/9/5/2), P＜0.05; the last follow-up (14/2/1/0) vs(9/8/1/1), P＜0.05]. Regarding to imaging, there was no significant difference in the quality of fracture reduction and the time of fracturehealing between the two groups (P＜0.05), while the HF group got significantly less the femorotibial angle than the DRF group (P＜0.05).[Conclusion] This BCFS used in HF configration might take advantages of avoiding the varus deformity of the distal femur, while achievingstable fixation over the DRF for distal femoral fractures, especially for the comminuted fractures.