切开复位解剖钢板内固定治疗股骨远端复杂骨折

Open reduction and internal fixation with anatomical plate to treat complex fractures of distal femur

目的探讨采用切开复位解剖钢板内固定治疗股骨远端复杂骨折的临床疗效。方法2001年1月～2004年6月采用切开复位解剖钢板内固定治疗股骨远端复杂骨折患者67例,25例C3型骨折选用股骨髁上支持钢板,42例A3、C2型骨折选用股骨远端接骨板;其中35例自体髂骨植骨,23例同种异体骨植骨,9例腓骨髓内植骨+髂骨植骨;全部患者在股四头肌与股骨之间应用生物可吸收医用膜;13例辅助髌骨牵引。术后常规中药熏洗、CPM锻炼等综合方法治疗。结果67例患者获得10～26个月(平均15个月)随访,骨折均获愈合,膝关节功能按Kolment标准评定:优36例,良23例,可5例,差3例,优良率为88.1%。结论切开复位解剖钢板内固定治疗股骨远端复杂骨折,固定可靠,可满足膝关节早期功能锻炼,有效防止股四头肌粘连和膝关节僵硬。辅助局部一期植骨、应用生物可吸收医用膜,部分髌骨牵引、术后中药熏洗、CPM锻炼等综合方法可获得满意疗效。

Objective To investigate the treatment of complex fractures of distal femur with open reduction and internal fixation with anatomical plate. Methods From January 2001 to June 2004, 67 cases of complex fractures of distal femur were treated with open reduction and anatomical plate internal fixation. The allogeneic bone was grafted for 23 cases, ilium was grafted for 35 cases, ilium and fibula were grafted for 9 cases. Bio-resorbable membranes were used between quadriceps femoris and femur. 13 cases were aided with patella traction. All the patients received fumigation and rinsing with Chinese herbs and CPM（continuous passive motion） after operation. Results All the 67 cases were followed up for 10 to 26 months. All the fractures got united. The postoperative knee functions were excellent in 36 cases, good in 23 cases, fair in 5 cases, and poor in 3 cases according to Kolment standards. The excellent and good rate was 88.1%. Conclusions Open reduction, internal fixation with anatomical plate, bone grafting, local use of bio-resorbable membranes, patella traction when necessary, fumigation and rinsing with Chinese herbs and CPM after operation are good measures to treat complex fractures of the distal femur, because they can provide stable fixation, allow early postoperative functional training, and prevent adhesion of quadriceps femoris and stiffness of the knee ioint.