股骨远端复杂类型骨折微侵袭治疗的疗效分析

Curative effect of minimally invasive plate osteosynthesis for complex fractures of the distal femur

目的评价微侵袭接骨板技术（minimally invasive plate osteosynthesis，MIPO）治疗股骨远端复杂类型骨折的治疗效果。方法2005年7月-2006年12月，通过MIPO联合股骨远端锁定加压钢板（locking compression plate，LCP）内固定治疗41例高能量创伤所致的股骨远端复杂类型骨折。其中男31例，女10例；平均年龄38岁（17～65岁）。AO／OTA33-A311例，C2 22例，C38例。开放性骨折16例。以临床功能和X线检查评定治疗效果。结果41例均获随访，平均随访时间8个月（2～18个月）。41例骨折全部愈合，平均愈合时间13周（7～16周）。未发生内固定失败和骨不愈合，浅表感染1例。膝关节活动度45°～135°，平均110°。美国特种外科医院（Hospital for Special Surgery，HSS）膝关节功能评分：优良36例，优良率88％。术后第2天与最后一次随访时相比，股骨下端轴线与股骨远端关节面切线夹角变化没有大于5°者。结论通过MIPO联合股骨远端LCP内固定治疗股骨远端复杂类型骨折创伤小，对软组织干扰少，能够获得并维持稳定固定，有利于骨折早期愈合，减少并发症发生。

Objective To evaluate the clinical results of minimally invasive plate osteosynthesis （MIPO） in treatment of complex fractures of the distal femur. Methods From July 2005 to December 2006, 41 patients with complex distal femur fractures induced by high energy trauma were treated with MIPO plus locking compression plate （LCP）. There were 31 males and 10 females, at average age of 38 years （17-65 years）. According to the AO/OTA fracture classification system, there were 11 patients with type A3 fractures, 22 with type C2 and 8 with type C3. There were 16 patients with open fractures. The clinical result was evaluated by using function examination and radiographic assessment. Results All patients were followed up for average 8 months （2-18 months） , which showed fracture healing, with mean healing time of 13 weeks （7-16 weeks）. There was only 1 patient with superficial infection but no fixation failure or implant breakage were found. The average knee range of motion was 110° （45°135°）. Hospital for special surgery knee rating scale （HSS） showed excellent or good results in 36 patients （88%）. No patient with greater than 5°difference in either varus or valgus was detected when compared 2 days after operation with latest follow-up. Conclusion In treatment of complex distal femur fractures, MIPO plus LCP have advantages of minor trauma, stable fixation, slight interference on soft tissues, early fracture healing and few complications.