半环式钢板内固定治疗股骨干粉碎性骨折的疗效分析

The design and curative effect of semicircular-plates in internal fixation of comminuted fractures of femoral shaft

目的探讨半环式钢板内固定治疗股骨干粉碎性骨折的疗效。方法采用半环式钢板内固定治疗205侧股骨干粉碎性骨折,其中Ⅱ型粉碎性骨折156侧,Ⅲ型49侧,分析疗效。结果205侧中196侧获6～13年的有效随访,其骨折对位良好,愈合牢固,钢板固定确实,未见肢体明显旋转、成角、短缩、畸形;其中6例膝关节伸屈小于30°,在取钢板同时行股四头肌腱松解术,术后膝关节伸、屈功能恢复至90°以上。疗效综合评定:优160侧,良22侧,尚可10侧,差3侧,优良率88.8%。结论依据股骨形状、力学特性所设计的半环式钢板,对粉碎性骨折碎片起到良好整复、固定作用,与现有单钢板比较,它的生物力学特性更为合理,改变现有钢板偏心固定不足、各髓内针固定造成分离的缺点;在股骨干粉碎性骨折内固定选择中,该钢板实为理想的内固定材料。

Objective To discuss the design and clinical effect of the semicircular-plates in treatment of comminuted fractures of the femoral shaft. Methods We designed a new internal fixation device, the semicircular-plates, for severe comminuted fractures of the femoral shaft. They were used in 205 sides of comminuted fractures of the femoral shaft. Of them, 156 were type Ⅱ and 49 were type Ⅲ. Results The follow-ups from 6 to 13 years were effectively conducted in 196 sides of the 205. We found that the alignment and union of the fractures were fine, and the fixation of the plates was stable. No obvious rotation, angulation, shortening or malformation of the limbs was found in the follow-ups, but in 6 sides the motion of the knee joint was restricted to less than 30°. When the plate was removed, tenolysis of the quadriceps was performed for the 6 sides and their conditions were all improved to more than 90°. 160 sides were rated as excellent, 22 as fine, 10 as fair, and 3 as poor, whith the excellent and fine rate being 88.8%. Conclusions The plates, designed according to the shape and mechanical features of the femur, can well reduce and fixate the fragments of the comminuted fracture of the femoral shaft. Their biomechanical performance is better than that of common plates, for they produce no deficiency of eccentric-fixation like current plates, or separation of bone fragments like medullary pins.