髁交锁逆行股骨髓内钉治疗股骨远端髁间骨折

Treatment of Intercondylar Fractures of Distal Femur with Condyle Retrograde Femur IntrameduUa Nail (CRFIN)

目的应用髁交锁逆行股骨髓内钉(condyle retrograde femur intramedulla nail,CRFIN)治疗股骨髁间骨折,探讨其手术适应证及疗效。方法2003年6月至2005年6月应用CRFIN治疗股骨髁间骨折12例,男9例,女3例;年龄25岁～48岁,平均35．2岁。AO分型B2型2例,C1型7例,C2型3例,其中3例合并髌骨骨折,3例合并股骨中段骨折。采取切开复位CRFIN内固定术。结果平均手术时间85．2分钟。全部病例获得随访12月～24月,平均16月。患者愈合平均时间15．2周(11周～23周),完全负重时间16．5周。术后发生关节僵硬1例,无感染、固定松动、断钉及失败病例。术后一年HSS评分平均88．3分(58分-97分),其中优8例、良3例、中1例。优良率91．2％。结论CRFIN为治疗股骨远端髁间骨折提供了一种新的治疗方法,特别是对常规方法难以处理的骨折。但是股骨髁问骨折发病率不高,还需要一定的病例和随访的积累才能确定其疗效。

Objective To evaluate the indications and clinical results of the condyle retrograde femur intramedulla nailing (CRFIN) in the treatment of intercondylar fractures of distal femur. Methods Between June 2003 and June 2005, 12 cases (9 males, 3 females) of distal femur intercondylar fractures (AO-type B2 2, C17, C2 3, and 3 cases combined with patella and 3 combined with middle shaft fractures) fracture were treated with condyle retrograde femur intramedulla nail. The mean age of the patients was 35.2 (range 25 to 48 years). All the cases were operated in an open reduction and internal fixation way with condyle retrograde femur intramedulla nail. Results The mean operation time was 85.2 min. The follow-up averaged 16 months ( range 12 to 24). The patients had a mean healing time of 15.2 weeks (11 to 24 weeks) and a mean weight bearing time of 16.5 weeks. Postoperatively, one knee joint stiffen occurred. No deep infection, loosening, breakage or failure of implant was noted. One year postoperatively, the mean HSS knee score was 88.3 (58 to 98) with 8 excellent, 3 good, 1 fair according to HSS scoring system. Conclusion condyle retrograde femur intramedulla nail is a novel operation method for the intercondylar fractures of distal femur, especially for those difficult to deal with in traditional way. But further clinical studies are required because of the low incidence of intercondylar fractures of distal femur.