新型板钉互锁系统内固定治疗全膝关节置换术后RorabeckⅡ型股骨假体周围骨折疗效观察  

Clinical efficacy of a new plate and nail interlocking system internal fixation in treatment of Rorabeck typeⅡfemoral periprosthetic fractures after total knee arthroplasty

作　　者：吴咏德 陈波[1] WU Yongde;CHEN Bo(Department of Orthopedics,Yichang First People's Hospital,Yichang,Hubei 443000,China)

机构地区：[1]三峡大学中心人民医院(宜昌市第一人民医院)骨科,三峡大学第一临床医学院,湖北443000

出　　处：《中国骨与关节损伤杂志》2025年第2期128-131,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的观察新型板钉互锁系统内固定治疗全膝关节置换术后RorabeckⅡ型股骨假体周围骨折的临床疗效。方法回顾性分析自2019-01—2023-12采用新型板钉互锁系统内固定治疗的6例全膝关节置换术后RorabeckⅡ型股骨假体周围骨折,于股骨远端前外侧入路复位骨折并临时固定,在肌层下方沿着股骨外侧置入锁定钢板,于髌旁内侧入路逆行置入髓内钉,通过瞄准臂微调髓内钉深度和角度,将锁定钢板的锁定钻套通过髓内钉远端瞄准器锁定导向孔置入锁定钢板远端的锁定钉孔,置入2枚锁定螺钉穿过髓内钉上的锁定孔到达远端内侧皮质,完成髓内钉和锁定钢板相互锁定。结果6例均获得随访,随访时间3~25个月,平均15个月。随访期间无感染、骨折畸形愈合、内固定失效、再骨折发生。骨折愈合时间8~21周,平均12周。末次随访时X线片显示骨折愈合良好,下肢力线恢复满意。末次随访时膝关节活动度为103.1°~109.7°,平均106.4°;疼痛VAS评分为1.1~1.3分,平均1.2分;膝关节功能AKS评分为157.7~200.0分,平均180.2分。结论采用新型板钉互锁系统内固定治疗全膝关节置换术后RorabeckⅡ型股骨假体周围骨折是可行的,逆行髓内钉与股骨的解剖轴线同轴置入,承重轴线更接近解剖轴线,在对抗内翻和外翻应力方面具有生物力学优势,锁定钢板内固定提供的稳定性可以减少骨折断端的异常活动,二者联合应用可以确保患者早期安全负重和功能锻炼。ObjectiveTo observe the clinical efficacy of a new plate nail interlocking system for internal fixation of Rorabeck typeⅡfemoral periprosthetic fractures after total knee arthroplasty.MethodsA retrospective analysis was conducted on 6cases of Rorabeck typeⅡfemoral prosthesis periprosthetic fractures treated with a new plate nail interlocking system from January 2019 to December 2023 after total knee arthroplasty.The fractures were reduced and temporarily fixed through the anterior lateral approach of the distal femur.A locking plate was placed along the lateral side of the femur below the muscle layer,and an intramedullary nail was retrogradely placed through the medial approach of the patella.The depth and angle of the intramedullary nail were fine tuned through the aiming arm,and the locking drill sleeve of the locking plate was inserted into the locking nail hole at the distal end of the locking steel plate through the guide hole of the intramedullary nail sight.Two locking screws were inserted through the locking holes on the intramedullary nail to reach the medial cortex of the distal end,completing the mutual locking between the intramedullary nail and the locking steel plate.ResultsAll 6 cases were followed up for 3-25months,with an average of 15 months.During the follow-up period,there were no infections,malunion of fractures,failure of internal fixation,or recurrence of fractures.The fracture healing time was 8-21 weeks,with an average of 12 weeks.At the last follow-up,the X-ray showed good fracture healing and satisfactory recovery of lower limb line;the motion of the knee joint ranged from 103.1°to 109.7°,with an average of 106.4°.The pain VAS score ranged from 1.1 to 1.3 points,with an average of 1.2points.The AKS score for knee joint function ranged from 157.7 to 200.0,with an average of 180.2 points.ConclusionThe use of a new plate nail interlocking system for internal fixation of Rorabeck typeⅡfemoral prosthesis fractures after total knee arthroplasty is feasible.The retrograde intramedull

关 键 词：股骨假体周围骨折 全膝关节置换术 新型板钉互锁系统 锁定钢板 髓内钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]