锁定接骨板“假锁”现象的新分型和上肢分布规律

Pseudolock phenomenon in locking plate osteosynthesis：classification and epidemiology in upper limb

摘要

目的：明确锁定板接骨术中假锁现象的定义，提出一种全新的具有临床指导意义的分型，研究假锁现象的发生率及其分布特征。方法：根据锁定头螺钉在接骨板螺纹孔中的置入状态将假锁现象分为3类：A型假锁，预成型锁定接骨板内的锁定头螺钉深度异常但方向正常；B型假锁，预成型锁定接骨板内的锁定头螺钉深度和方向均异常；C型假锁，过度折弯的接骨板内的锁定头螺钉深度和/或方向异常。采用回顾性队列研究设计，收集并分析2017年6月—2024年4月接受锁定板接骨术治疗的1 796例上肢长骨（锁骨、肱骨、尺骨和桡骨）骨折病例资料及术后影像学数据。采用Bonferroni校正的卡方检验来评估性别、年龄、侧别、骨骼类型、骨折部位和螺钉直径各分组的假锁发生率差异。结果：共纳入1 878块锁定接骨板，包含锁骨1 129块（60.1%）、肱骨364块（19.4%）、尺骨137块（7.3%）、桡骨248块（13.2%），共计11 636枚锁定头螺钉。假锁现象总体发生率为22.0%（2 564/11 636）。其中，A型假锁最为常见，发生率为14.1%（1 646/11 636）；B型次之，为7.8%（911/11 636）；C型罕见，为0.1%（7/11 636）。结论：本研究定义了锁定板接骨术中的“假锁”现象，并建立了全新的分型。假锁现象在上肢长骨（锁骨、肱骨、尺骨及桡骨）接骨术中发生率超过1/5。熟悉接骨板预设的螺钉置入深度和方向、术中使用切线位透视有效识别假锁现象，是提升锁定接骨板固定可靠性的重要环节。

Abstract

Objective：To clarify the definition of pseudolock phenomenon during locking plate osteosynthesis，propose a novel clinically oriented classification，and explore the incidence and distribution characteristics of this phenomenon. Methods：According to the insertion state of locking head screws in the threaded holes of locking plates，the pseudolock phenomenon was classified into three types：Type A，the screw depth is insufficient，but the orientation is normal in a precontoured plate；Type B，both the screw depth and orientation are abnormal in a precontoured plate；Type C，the screw depth and orientation are either/both abnormal in an overbent plate. Demographic and radiographic data of 1 796 patients with upper limb long bone fractures（clavicle，humerus，ulna，and radius）who underwent locking plate osteosynthesis from June 2017 to April 2024 were collected and analyzed. A Chi-square test with Bonferroni correction was used to assess the incidence of pseudolock incidences across different genders，ages，sites，sides，locations，and diameters. Results：A total of 1 878 locking plates were identified in the long bones of the upper limbs，distributed as follows：clavicle 1 129（60.1%），humerus 364（19.4%），ulna 137（7.3%），and radius 248（13.2%）. In total，11 636 locking head screws placed in these plates were included in the analysis，of which 2 564（22.0%）were pseudolocked. Type A pseudolock was the most common with an incidence of 14.1%（1 646/11 636），followed by Type B at 7.8%（911/11 636），while Type C was rare with an incidence of 0.1%（7/11 636）. Conclusion：The pseudolock phenomenon in locking plate osteosynthesis is defined and a new classification system is established. The incidence of pseudolock exceeds 20% in osteosynthesis of upper extremity long bones including clavicle，humerus，ulna and radius. Mastering the preset insertion depth and orientation of screws for locking plates and identifying pseudolock timely via tangential fluoroscopy during operation are crucial measures to improve the fixation stability of locking plates.

关键词

锁定板接骨术 / 骨折 / 锁定头螺钉 / 锁定接骨板 / 分型

Key words

locking plate osteosynthesis / fracture / locking head screw / locking compression plate / classification

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基金资助

国家自然科学基金(82472436)

江苏省重点研发计划社会发展项目(BE2023756)