锁定钢板和传统钢板治疗股骨骨折内固定断裂率比较分析

吴率帅，陈伟，王娟等.锁定钢板和传统钢板治疗股骨骨折内固定断裂率比较分析[J].中华创伤杂志.2013, 29(3):254-257.

股骨骨折,锁定钢板,传统钢板,内固定断裂率

吴率帅，陈伟，王娟，徐国辉，陈霄，刘勃，许斌，张英泽

河北医科大学第三医院创伤急救中心, 石家庄,050051

2013

254-257

知网,万方

目的 比较锁定钢板和传统钢板治疗股骨骨折的内固定断裂率,分析失败原因,为减少内固定断裂的发生提供依据. 方法 选择2009年5月-2011年1月我院收治的股骨骨折钢板内固定患者280例,其中男146例,女134例；年龄18 ～92岁,平均52.4岁.左侧136例,右侧144例.股骨骨折按照AO分型:31A型72例；32A型44例,32B型26例,32C型30例；33A型57例,33B型26例,33C型25例.锁定钢板内固定175例,传统钢板内固定105例. 结果 术后随访9 ～ 40个月,锁定钢板组内固定断裂率为4％,传统钢板组内固定断裂率为2.9％(P＞0.05).断裂方式:钢板断裂6例,螺钉断裂3例,钢板断裂合并螺钉断裂1例.断裂原因:医源性因素合并康复锻炼错误导致内固定断裂率为100％,单纯医源性因素导致内固定断裂率为36.4％,单纯康复锻炼错误致内固定断裂率为5.4％,无医源性因素和康复锻炼正确导致内固定断裂率为0,医源性因素合并康复锻炼错误导致内固定断裂率明显高于单纯医源性因素、单纯康复锻炼错误、无医源性因素和康复锻炼正确. 结论 锁定钢板和传统钢板治疗股骨骨折内固定断裂率无差异,医源性因素合并康复锻炼错误是导致内固定断裂的主要原因. Objective To compare the breakage rate of locking plate and traditional plate in treatment of femoral fractures,analyze failure reasons and offer a basis for decreasing breakage rate of the plates.Methods The study included 280 patients with femoral fractures managed by plate fixation from May 2009 and January 2011.There were 146 males and 134 females,at age of 18-92 years (mean 52.4 years).There were 136 patients with left femoral fractures and 144 patients with right femoral fractures.According to AO classification,there were 72 patients with type 31A fractures,44 with type 32A fractures,26 with type 32B fractures,30 with type 32C fractures,57 with type 33A fractures,26 with type 33B fractures and 25 with type 33C fractures.A total of 175 patients were treated with locking plate and 105 with traditional plate.Results Follow-up ranged from 9 months to 40 months,which displayed implant breakage rate of 4.0 ％ in the locking plate group and of 2.9％ in the traditional plate group (P ＞ 0.05).Breakage modes included plate fracture in six patients,screw fracture in three,plate combined with screw fractures in one.Causes for breakage were iatrogenic factors plus false rehabilitation training with implant breakage rate of 100％,simply iatrogenic factors with implant breakage rate of 36.4％,and simply false rehabilitation training with implant breakage rate of 5.4％.However,non-iatragenic factors plus correct rehabilitation training brought no implant breakage.Consequently,breakage rate of the implant related to iatrogenic factors plus false rehabilitation training were significantly higher than that associated with simply iatrogenic factors,simply false rehabilitation training,or non-iatragenic factors plus correct rehabilitation training.Conclusion Breakage rate of the locking plate and the traditional plate in treatment of femoral fractures shows no significant difference,but iatrogenic factors combined with false rehabilitation training are the leading cause for the implant breakage.