股骨远端复杂骨折的手术治疗

Surgical treatment of complex fracture of distal femur

目的 评价应用髁动力加压钢板（DCS）、股骨髁上逆向交锁髓内钉（GSHN）或股骨髁支撑钢板内固定治疗股骨远端复杂骨折的临床疗效。方法 手术治疗34例（36侧）股骨远端复杂骨折。开放性骨折9侧，闭合性骨折27侧；AO／ASIF分类A3型16侧，C2型9侧，C3型11侧。17侧选用了切开复位DCS内固定的方法进行治疗，7侧使用GSHN固定，12侧选用了切开复位股骨髁支撑钢板内固定的方法。术后5～7d在CPM机辅助下行渐进性膝关节功能锻炼。结果 随访6～43个月。36侧骨折中，无一例感染及骨折不愈合发生。按Kolment疗效评定标准评定：优19侧，良11侧，可5侧，差1侧，优良率为83．3％。结论 手术治疗股骨远端复杂骨折获得满意疗效需要满足以下条件：力争达到解剖复位；坚强的内固定；尽可能保护骨折断端血供，减少骨折处及其周围软组织的损伤；能提供术后相对早期的康复训练的基础。应用DCS或GSHN治疗股骨远端复杂骨折，对于部分病例可达到上述四点要求．而用股骨髁支撑钢板则相对较困难。

Objective To evaluate the clinical outcomes of the treatment of complex fracture of distal femur by internal fixation with dynamic condylar plates, GSHN or condylar buttress plates. Methods Thirty six cases with complex fracture of distal femur were treated by operations. There were 9 patients with open fracture and 27 cases closed fracture. By AO/ASIF classification, there were 16 cases of type A3,9 cases of type C2, 11 cases of type C3. There were 17 cases treated with open reduction and internal fixation with dynamic condylar plates, 7 cases with internal fixation with GSHN and 12 cases with open reduction and internal fixation with condylar buttress plates. From 5 to 7 days after operation,all 36 cases started to exercise their knee joints gradually with CPM. Results The mean follow-up was 22.5 months （6-43 months）. In 36 cases, no infection occurred and no one was ununion. The outcome was evaluated with Kolment rating system, 19 cases were graded as excel lent,11 cases as good, 5 cases as fair, 1 ease as poor, knee joint funclion was excellent to good in 83.3%. Conclusion To get satisfctory clinical effects in treating complex fractures of distal femur by operations,it must fulfil several conditions such as getting anatomical reduction, rigid internal fixation, trying our best to conserve blood supplying for fracture segments and reducing injury of fractures and tissues around,providing the base of relatively early recovery exercise after operations. Using DCS or GSHN to treat complex fracture of distal femur can make some of the cases to fulfil these four demands,while condylar buttress plates can not.