锁定接骨板“假锁”现象的新分型和上肢分布规律
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江苏大学附属人民医院

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国家自然科学基金面上项目(编号:82472436);江苏省重点研发计划社会发展项目(编号:BE2023756)


Pseudolock phenomenon in locking plate osteosynthesis: classification and epidemiology in upper limbYao Xiang1,2, Miao Han2, Liu Shengjie2,3, Shao Rongyang2, Tang Yilin2, Tang Jilei4, Hu Minjie1
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Naional Natral Science Foundanion of China's General program (N0.824724360), Special Fund Projects of Jiangsu Science and Technology Program (N0.BE2023756)

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    摘要:

    目的:锁定板接骨术是治疗四肢长骨骨折的常用内固定术式。锁定接骨板(又称锁定内支架)通过锁定头螺钉与板体交锁形成角稳定结构,提供可靠的力学支持。临床实践中,锁定头螺钉与接骨板螺孔未能正确交锁耦合的现象普遍存在,但目前尚无明确的学术定义与分类,也缺乏针对上肢长骨骨折中分布规律的总结。本研究旨在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,并回顾性分析上肢长骨骨折患者中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三类: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06月至2024年04月期间于我院接受锁定板接骨术治疗的1796例上肢长骨骨折(锁骨、肱骨、尺骨和桡骨)病例。收集人口统计学资料及术后影像学数据,三名观察员使用新的分类系统评估每个锁定头螺钉的放置状态。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1878块锁定接骨板,包含锁骨1129块(60.1%)、肱骨364块(19.4%)、尺骨137块(7.3%)、桡骨248块(13.2%)。共计11636枚锁定头螺钉。假锁现象总体发生率为22.0%(2564/11636)。其中,A型假锁最为常见,发生率为14.1%(1646/11636);B型次之,为7.8%(911/11636);C型罕见,为0.1%(7/11636)。结论:本研究首次定义了锁定板接骨术中的“假锁”现象,并建立了全新的分型,是当前创伤骨科内固定理论体系的重要补充。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,是临床实践中一个尚未被充分重视的常见技术失误。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: Locking plate osteosynthesis is one of the most widely used methods for fracture fixation. These components, the locking head screw (LHS) and the locking plate (or locking brace), engage via matching threads to create an angularly stable construct. This provides reliable mechanical support and promotes fracture healing. However, the nonstandard placement of locking head screw remains a concern. The present study aims to introduce a new classification and describe the epidemiology of the pseudolock phenomenon in upper limb locking plate osteosynthesis. Methods: Herein, a new classification was proposed. 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 from patients with upper limb long bone fractures (clavicle, humerus, ulna, and radius) treated with locking plate osteosynthesis were retrospectively analyzed. The placement status of each locking head screw was assessed by three observers using the new classification system. 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. The study cohort comprised 1796 patients who underwent locking plate osteosynthesis at our hospital between 01/06/2017 and 30/04/2024. Result: A total of 1878 locking plates were identified in the long bones of the upper limbs, distributed as follows: clavicle 1129 (60.1%), humerus 364 (19.4%), ulna 137 (7.3%), and radius 248 (13.2%). In total, 11636 locking head screws placed in these plates were included in the analysis, of which 9072 (78.0%) were standardly locked, and 2564 (22.0%) were pseudolocked. Among the pseudolocked screws, 1646 (14.1%) were classified as Type A, 911 (7.8%) as Type B, and 7 (0.1%) as Type C. Conclusion: This study first proposed the pseudolock concept. The new pseudolock concept and classification aid in characterizing the placement status of locking head screws and is a significant supplement to the theoretical system of internal fixation in orthopedics. The incidence of pseudolock phenomenon in locking plate osteosynthesis of the upper limb is more than 20% and the pseudolock phenomenon cannot be ignored in clinical practice. The standardized placement of LHS and the tangential fluoroscopy during surgery can effectively identify pseudolock phenomena. This helps to improve the reliability of locking plate osteosynthesis and better promote fracture healing.

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  • 收稿日期:2025-12-25
  • 最后修改日期:2026-04-29
  • 录用日期:2026-05-27
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