以微創經皮鋼板內固定術治療股骨遠端骨折：
動力髁螺釘（DCS）與微創內固定系統（LISS）之比較

研究目的：以非直接於骨折碎片上施行之經皮鋼板內固定術來治療股骨遠端骨折可有良好之臨床預後。傳統經皮鋼板內固定術通常使用動力髁螺釘（dynamic condylar screw,簡稱DCS）及微創骨折內固定系統(Less Invasive Stabilization System,簡稱LISS)來執行。生物力學研究顯示LISS，系統具備較高負荷載重能力。但目前並無研究針對以DCS與LISS系統治療股骨遠端骨折之差異做比較。本研究之研究目的即在概述以DCS及LISS治療股骨遠端骨折之所有臨床及影像結果差異。研究方法及資料：本研究以無使用骨植入體之DCS或LISS方法執行45例微創經皮鋼板內固定術來治療股骨髁上或髁間骨折。有26位病人26例骨折以動力髁螺釘治療，為DCS組;19位病人19例骨折以微創骨折內固定系統治療，為LISS組。我們針對此兩種不同固定裝置之臨床及影像結果資料進行比較。研究結果：45例中有41例達到完全癒合（91.1％），DCS組之成功率為96.2％，LISS組為94.7％（P = 0.672）;DCS組之平均融合時間為19.18週，LISS組為19.38週（P = 0.835）;DCS組之膝關節平均活動範圍(range of motion,簡稱ROM)為111.65度，LISS組為116.26度（p=0.334）。早期植體失敗只發生在DCS組（11.5％，p=0.252，勝算比=1.826 [95％ CI：1.387∼2.404]）。DCS組之併發症總發生率為15.4％，LISS組為15.8％（P=0.641）;DCS組之平均骨折冠狀面活動損失角度為-0.77度，LISS組為-0.19度（P=0.125）。結論與建議：以DCS或LISS施行微創經皮鋼板內固定術治療股骨遠端骨折皆能達到良好且併發症少之預後。兩者皆能使軟組織受到最低創傷。但微創骨折內固定系統(LISS)比動力髁螺釘（DCS）有較低之早期置入鬆脫風險。

關鍵字

遠端股骨；微創經皮鋼板內固定術；動力髁螺釘；微創骨折內固定系統；鎖定式鋼板

並列摘要

Background: Treatment of distal femoral fractures by percutaneous plating without direct manipulation of the fracture fragments leads to good clinical outcome. Percutaneous plating has traditionally involved using a dynamic condylar screw (DCS) and the less invasive stabilization system (LISS) was reported. The biomechanical study showed that the LISS had the enhanced ability to withstand higher loads. However, there were no clinical comparison study of distal femoral fractures treated with DCS and LISS. The aim of this study was to outline any differences in clinical and radiological results between the DCS and the LISS for treating distal femoral fractures. Methods: Forty-five supracondylar or intercondylar femoral fractures were treated by minimally invasive percutaneous plating with the DCS or the LISSwithout bone graft. There were 26 patients with 26 fractures in the DCS group and 19 patients with 19 fractures in the LISS group. The data of the clinical and radiographic outcomes were compared between the two different fixation devices. Results: Complete union was achieved in 41 of the 45 patients (91.1%). The success rate was 96.2% in the DCS group and 94.7% in the LISS group (p = 0.672). The mean fusion time was 19.18 weeks in the DCS group and 19.38 weeks in the LISS group (p = 0.835). The average range of motion of the knee joint was 111.65 degrees in the DCS group and 116.26 degrees in the LISS group (p = 0.334). Early implant failure only occurred in the DCS group (11.5%, p = 0.252, odds ratio =1.826 [95% CI: 1.387–2.404]). The total complication rate was 15.4% in the DCS group and 15.8% in the LISS group (p = 0.641). The mean loss of coronal fracture fragment angle was -0.77 degrees in the DCS group and -0.19 degrees in the LISS group (p =0.125). Conclusion: Minimally invasive percutaneous plating with the DCS or the LISS provides good outcome with few complications in the treatment of distal femoral fractures. Both systems minimize soft tissue trauma. LISS has lower risk of early implant loosening than the DCS.

並列關鍵字

Distal femur ； Minimally invasive ； Percutaneous plating ； Dynamic condylar screw ； LISS ； Locking plate

參考文獻

1. Giles JB, DeLee JC, Heckman JD, Keever JE. Supracondylar intercondylar fractures of the femur treated with a supracondylar plate and lag screw. J Bone Joint Surg Am. 1982;64:864-870.

2. Neer CS II, Grantham SA, Shelton ML. Supracondylar fracture of the adult femur: a study of one hundred and ten cases. J Bone Joint Surg Am. 1967;49:591-613.

3. Olerud S. Operative treatment of supracondylar-condylar fractures of the femur: technique and results in fifteen cases. J Bone Joint Surg Am. 1972;54:1015-1032.

4. Schatzker J, Lambert DC. Supracondylar fractures of the femur. Clin orthop. 1979;138:77-83.

5. Kregor PJ, Zlowodzki M. Distal femur fractures. Surgical Treatment of Orthopaedic Trauma. 2007;633-663.

延伸閱讀

Peng, M. C., Lin, H. T., Lee, Y. C., Chen, C. P., Hsieh, H. P., & Lee, Y. H. (2020). 植入髓內鋼釘治療股骨近端骨折，葉片螺釘位置與股骨頭穿孔之關係研究. 輔仁醫學期刊, 18(1), 1-9. https://doi.org/10.3966/181020932020031801001
Yew, C. W., Chang, C. Y., & Shen, P. W. (2010). 動態髖螺釘聯合粒隆支持鋼板與動態髖螺釘應用於股骨粗隆周圍骨折之治療結果比較. Formosan Journal of Surgery, 43(1), 12-19. https://doi.org/10.29833/FJS.201002.0003
Shih, S. L., Cheng, C. K., & Chen, C. S. (2015). 以不同長度側鋼板之動態髖骨釘治療骨粗隆骨折－有限元素分析. 北市醫學雜誌, 12(1), 28-41. https://doi.org/10.6200/TCMJ.2015.12.1.03
Ozer, A. F., Keskin, F., Oktenoglu, T., Suzer, T., Ataker, Y., Gomleksiz, C., & Sasani, M. (2013). A Novel Approach to the Surgical Treatment of Lumbar Disc Herniations: Indications of Simple Discectomy and Posterior Transpedicular Dynamic Stabilization Based on Carragee Classification. Advances in Orthopedics, 2013(), 42-47. https://doi.org/10.1155/2013/270565
Chiu, C. H., Wu, C. C., Feng, K. F., Tseng, I. C., Lee, P. C., & Chou, Y. C. (2009). Optimal Location of Lag Screw of Dynamic Hip Screw in Femoral Head during Treating Unstable Intertrochanteric Fractures in Elderly Patients. Journal of Orthopaedic Surgery Taiwan, 26(4), 162-169. https://www.airitilibrary.com/Article/Detail?DocID=10116923-200912-201001150086-201001150086-162-169

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以微創經皮鋼板內固定術治療股骨遠端骨折：動力髁螺釘（DCS）與微創內固定系統（LISS）之比較

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