股骨远端骨折的分型和治疗

Classification and treatment of distal femoral fractures

目的分析股骨远端骨折的分型和治疗。方法回顾性总结1995-2003年间的603例股骨远端骨折患者,男301例,女302例;年龄0.6～85岁,平均42.6岁。根据M櫣ller分型,A型282例,B型98例,C型223例;开放性骨折58例(9.6%)。非手术治疗134例,手术治疗469例。结果股骨远端A、B和C型骨折治疗后Neer评分依次降低,分别为73.4±13.9、64.9±14.7和59.2±14.8;手术治疗组Neer评分明显优于非手术治疗组。B型骨折中单纯性骨折和粉碎性骨折的治疗和预后有较大区别。结论股骨远端骨折应根据不同类型而采用不同的手术和内固定方法治疗,其中B型骨折应以骨折的累及范围和粉碎程度分为三种亚型,选择相应的内固定方法更为合理。

Objective To analyze the classification of distal femur fractures and understand thechoice of tre atment according to the classification. Methods A retrospective study was carried out in 603 cases （301 males and 302 females, with age range of 0.6-85 years, average 42.6 years） with distal femur fractures treated from 1995 to 2003. According to the Miiller classification, there were 282 cases of type A fractures, 98 type B and 223 type C. Fifty-eight cases （9.6%） were with open fractures. Of all,134 fractures were treated by conservative methods, 469 by surgical operation, 18 by compression plates,15 by ＂T＂ - or ＂L＂ -shaped plates, 74 by femoral condylar blade plates, 112 by dynamic condylar screw, 97 by femoral condylar plates, 23 by femoral locked nails, 41 by distal femoral nails, 55 by external fixators and 34 by others. Results The average Neer scores of type A, B and C fractures were decreased to 73.4 ＋ 13.9, 64.9±14. 7 and 59.2±14.8 respectively. The average Neer score of surgery was significantly better than that of conservative methods. There existed marked differences in treatment and prognosis between the simple and comminuted fractures in type B fractures. Conclusions Distal femur fractures should be treated according to fracture classification. Based on the involved areas and comminution degrees, type B fractures should be grouped into three subtypes that then can be treated by suitable fixation method.