Unilateral locking versus bilateral locking bone plates combined with cortical dissection bone grafting for treatment of nonunion of femoral shaft fractures: efficacy and impact on joint function

doi:10.3877/cma.j.issn.1674-0785.2021.12.011

Abstract

Abstract:

Objective

To compare the efficacy of unilateral locking and bilateral locking plates combined with cortical dissection in the treatment of nonunion of femoral shaft fractures and explore their effects on joint function.

Methods

A total of 62 patients with nonunion of femoral shaft fractures admitted to Dushu Lake Hospital Affiliated to Suzhou University from May 2016 to May 2020 were selected. The patients were randomly divided into an observation group of 33 cases and a control group of 29 cases. The control group was treated with a unilateral locking bone plate combined with cortical dissection and bone grafting. The observation group was treated with bilateral locking plates combined with cortical dissection and bone grafting. Operative parameters, postoperative recovery, knee range of motion, and knee function recovery were compared between the two groups.

Results

The operation time of the observation group was significantly longer than that of the control group (P＜0.05), but there was no significant difference in the amount of perioperative bleeding, time to ambulation, and hospital stay after operation (P＞0.05). There was no significant difference in the range of motion of the knee joint between the two groups at 1 month after surgery (P＞0.05); the range of motion of the knee joint in the observation group was greater than that in the control group at 3, 6, and 12 months after surgery (P＜0.05 each). At 12 months after operation, the excellent and good rate of the knee joint function, as assessed by knee society score, was significantly higher in the observation group than in the control group (P＜0.05).

Conclusion

Bilateral locking plates combined with cortical dissection and bone grafting can effectively promote the healing of the fracture site in patients with femoral shaft graft fracture nonunion, and contribute to the improvement of knee joint range of motion and knee joint function, which is worthy of clinical promotion.

Key words: Unilateral locking, Bilateral locking, Cortical dissection bone graft, Femoral shaft fracture nonunion, Curative effect, Joint function

Xi'an Wang, Weimin Jiang, Fan Zhang, Weigang Jiang, Hanliang He. Unilateral locking versus bilateral locking bone plates combined with cortical dissection bone grafting for treatment of nonunion of femoral shaft fractures: efficacy and impact on joint function[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(12): 972-977.

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Figures/Tables 6

临床资料	观察组（33例）	对照组（29例）	t/χ²值	P值
性别［例（%）］			0.104	0.767
男	18（54.55）	17（58.62）
女	15（45.45）	12（41.38）
年龄（岁， $x ¯$ ±s）	47.48±9.38	46.21±10.37	0.506	0.615
BMI（kg/m²， $x ¯$ ±s）	23.03±3.21	23.16±2.11	0.187	0.853
骨折部位［例（%）］			0.030	0.976
中段	9（27.27）	7（24.14）
中上段	13（39.39）	13（44.83）
中下段	11（33.33）	9（31.03）
首次手术方式［例（%）］			0.974	0.330
钢板螺丝钉固定	10（30.30）	6（20.69）
髓内钉固定	21（63.64）	20（68.97）
外固定支架固定	2（6.06）	3（10.34）

临床资料	观察组（33例）	对照组（29例）	t/χ²值	P值
性别［例（%）］			0.104	0.767
男	18（54.55）	17（58.62）
女	15（45.45）	12（41.38）
年龄（岁， $x ¯$ ±s）	47.48±9.38	46.21±10.37	0.506	0.615
BMI（kg/m²， $x ¯$ ±s）	23.03±3.21	23.16±2.11	0.187	0.853
骨折部位［例（%）］			0.030	0.976
中段	9（27.27）	7（24.14）
中上段	13（39.39）	13（44.83）
中下段	11（33.33）	9（31.03）
首次手术方式［例（%）］			0.974	0.330
钢板螺丝钉固定	10（30.30）	6（20.69）
髓内钉固定	21（63.64）	20（68.97）
外固定支架固定	2（6.06）	3（10.34）

组别	例数	手术时间（min）	术中出血量（ml）	术后下床活动时间（d）	住院时间（d）
观察组	33	119.38±20.31	238.95±35.64	5.19±1.25	7.29±2.16
对照组	29	86.79±15.44	231.49±40.11	5.03±1.42	7.36±2.09
t值		7.035	0.776	0.472	0.129
P值		＜0.001	0.441	0.639	0.898

组别	例数	术后1个月	术后3个月	术后6个月	术后12个月
观察组	33	85.73±4.32	105.85±4.91	132.12±5.45	139.94±7.81
对照组	29	83.91±4.74	100.92±3.84	126.81±7.41	134.86±5.74
t值		1.582	4.360	3.240	2.884
P值		0.119	＜0.001	＜0.001	＜0.001

组别	例数	优	良	可	差	优良率（%）
观察组	33	18（54.55）	12（36.36）	2（6.06）	1（3.03）	90.91
对照组	29	13（44.82）	7（24.14）	7（24.14）	2（6.90）	68.96
χ²值						4.762
P值						0.029

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