闭合复位逆行髓内钉治疗股骨远端骨折两种术式比较

Closed reduction and retrograde nailing internal fixation for distal femoral fractures: comparison of two operation modalities

目的探讨股骨逆行髓内钉治疗股骨远端骨折时手术操作技术改进的优点。方法A组34例,采用膝关节前外侧特殊小切口,在手指指导下关节面复位,闭合复位髁上骨折;B组23例,采用关节镜指导下闭合复位内固定;两组术后第1天均开始膝关节功能训练。比较两组透视次数及术中使用关节镜的优缺点。结果A组术中透视平均(7.6±3.1)次,B组术中透视平均(15.8±3.9)次,两组比较差异有显著性意义(P<0.05)。两组髁间骨折关节面复位满意,伤口均一期愈合。A组伸膝均达0°,屈膝平均(115.2±21.6)°,微跛3例,膝关节轻微疼痛5例,膝关节功能优23例,良4例,可2例。B组伸膝均达0°,屈膝平均(105.4±18.8)°,微跛4例,膝关节轻微疼痛4例,膝关节功能优9例,良6例,可2例。结论采用膝关节前外侧特殊切口可以有效地指导闭合复位,恢复关节面平整,不需在透视下确定髓内钉在髁间窝的入口、扩髓、置入髁内钉及确定锁钉位置,减少放射线对医护人员及患者的照射,避免使用关节镜,缩短了手术时间。

Objective To discuss the operation techniques in retrograde nailing for closed reduction and internal fixation of distal femoral fracture and try to avoid using arthroscope and decrease X-ray exposure. Methods The author studied 57 cases of closed distal femoral fracture using retrograde intramedullary hall and different operation procedures were compared. Group A （ n= 34） was operated with special minimal invasive incision and closed reduction was achieved with less intraoperative fluoroscopy. Group B（ n = 23） was operated with arthroseope to view intercondylar fracture lines and to conduct closed reduction. Physical therapy began on the first postoperative day in both groups. Results Average intraoperative fluoroscopy times was 7.6 ± 3.1 in Group A and 15.8 ± 3.9 in Group B （ P 〈 0. 05 ）. All patients achieved primary healing and reduction was satisfactory and no unacceptable angulations occurred in either group. In Group A, the average extension grade was 0°and flexion （ 115.2 ± 21.6）°. Three cases had mild elaudieation and 5 cases had mild pain. The joint function of the knee was graded excellent in 23 cases, good in 4 cases, and fair in 2 cases. In Group B, the average extension grade was 0°and flexion （ 105. 4±18. 8）°. Four cases had mild elaudieation and 4 cases had mild pain. The joint function was graded excellent in 9 cases, good in 6 cases, and fair in 2 cases. Conclusion The special minimal invasive incision is preferable because it can effectively conduct closed reduction, restore a smooth articular surface, avoid using arthroscope and hence decrease the exposure of surgeons and patients to X ray and shorten operation time.