股骨远端复杂骨折手术治疗方法的选择与评价

Treatment choice and evaluation of complex distal femoral fractures

目的评价股骨远端复杂骨折各种手术治疗方法及临床疗效,为临床选择合理的手术方法,提高手术疗效提供依据。方法本组46例股骨远端复杂骨折按AO的Müller分类,按手术治疗方法分组:髁动力加压钢板(DCS)16例(A3型3例,C2型8例,C3型5例);股骨髁支撑钢板14例(A3型6例,C2型4例,C3型4例);自锁髁钢板10例(A3型6例,C2型2例,C3型2例);股骨髁上逆向交锁髓内钉6例(A3型4例,C2型2例)。根据膝关节Kolmert临床标准的评价对各种手术方法进行1.5～2年临床疗效随访观察。结果 46例骨折中,无一例感染及骨折不愈合发生。按Kolment疗效评定标准评定:优27例,良9例,可7例,差3例。结论手术治疗股骨远端复杂骨折临床疗效可靠,其手术治疗的成功有赖于:手术方法的正确选择;骨折的良好复位;坚强牢固的内固定,能为术后相对早期康复训练提供保障;骨折断端血供的良好保护,防止骨折处及其周围软组织的继发损伤。

Objective To evaluate treatment methods and clinical efficacy of complex distal femoral fractures,to choose reasonable surgical method,to provide a basis for improving surgical outcomes.Methods The 46cases of distal complex fractures were classified by AO Müller classification and surgical treatment methods as follows：condyle dynamic（DCS）16 cases（A3 3 cases,C2 8 cases,C3 5 cases）;femoral condyle plate 14 cases（A3 6 cases,C2 4 cases,C3 4 cases）;self-locking plate10 cases（A3 6 cases,C2 2 cases,C3 2 cases）;distal reverse nails 6 cases（A3 4 cases,C2 2 cases）.According to the knee Kolmert evaluation of clinical standards on a variety of surgical techniques clinical follow-up was done for 1.5-2 years.Results In the 46 bone fractures,infection and fracture did not occur.According to Kolment evaluation standard on curative effect：superior 27,good 9,not bad 7bad,difference 3.Conclusions the clinical efficacy of surgical treatment for complex distal femoral fractures is satisfactory,depending on：correct choice of surgery method;good replacement of bone fracture ;strong internal fication,for early recovery training ;protection of the end blood supplies,for preventingthe secondaryinjury in fractures and surrounding soft tissues.