股骨髁上骨折的手术治疗

Operative treatment of supracondylar femoral fractures

目的探讨提高股骨髁上骨折的手术治疗效果。方法(1)取6具人尸体新鲜股骨标本,制成有1cm骨缺损的股骨髁上骨折。采用逆行带锁髓内针和股骨髁支撑钢板两种内固定器材分别固定各骨折。对固定后的骨折进行应力测定,比较两种内固定物固定骨折的生物力学特性。用SPSS统计软件对结果进行分析。(2)对1995年8月到2000年12月收治的并可随访到的36例37肢体股骨髁上骨折(主要对其中的股骨髁支撑钢板16例16肢体,逆行带锁髓内针14例15肢体)进行临床随访分析,比较逆行带锁髓内针与股骨髁支撑钢板手术治疗股骨髁上骨折的临床结果。结果(1)生物力学性能用股骨髁支撑钢板固定的骨折的抗压缩强度值低于用逆行带锁髓内针固定。用股骨髁支撑钢板固定的骨折的抗弯曲的强度值高于用逆行带锁髓内针固定。( 2 )临床结果根据Neer膝关节功能评分标准,本组病例共有优秀26肢体,良好8肢体,可以1肢体,差2肢体。总体优良率91 9%。钢板类优良率94 7%,髓内针93 3%。膝关节屈伸活动范围平均110°。结论手术治疗股骨髁上骨折可获得良好的结果。逆行带锁髓内针和股骨髁支撑钢板固定在生物力学性能及临床应用方面各有优势。

Objective Biomechanical properties between retrograde nail and condylar buttress plate for supracondylar femoral fracture were tested and compared. The functional operative results were also followed and analyzed. Methods (1)Six fresh adult moist cadaveric femoral specimens were used to create femoral supracondylar fracture models. Six specimens were divided into two groups . Group 1 was fixed with retrograde locking intramedullary nail and group 2 with condylar buttress plate. All specimens undergone biomechanical test and the data were analyzed using SPSS software.(2)From August 1995 to December 2000, 36 cases(37 limbs) of femoral supracondylar fracture were included. The follow-up period ranged from 2.1 years to 7.5 years. Results (1) Biomechanical tests showed: The stiffness of the condylar buttress plate in resisting axial compression force was smaller than that of the retrograde locking intramedullary nail. condylar buttress plate showed larger stiffness in resisting bending force than the retrograde locking intramedullary nail. (2) Clinical outcomes: According to Neer rating system, the functional scores were excellent in 26 cases, good in 8, fair in 1 and poor in 2. The excellent-good rate was 91.9%. The excellent-good rate of plating cases was 94.7% and retrograde nail was 93.3%. ROM of the knee joint ranges from 60°to 135°, with an average of 110°. Conclusion The excellent or good outcomes of femoral supracondylar fracture could be obtained through the operative treatment. The fixation of the retrograde locking and condylar buttress plate have their own advantages in biomechanical properties.