手术治疗股骨骨折合并同侧胫腓骨骨折的临床分析

Surgical Treatment of Femoral Fractures,and Clinical Study of Ipsilateral Tibia and Fibula Fracture

目的总结股骨骨折合并同侧胫腓骨骨折的手术方法和治疗效果。方法从2003年8月至2008年10月共手术治疗28例,股骨骨折按AO分类法,A1型5例,A2型4例,A3型3例,B1型4例,B2型4例,B3型2例,C1型3例,C2型2例,C3型1例。胫腓骨骨折按AO分类,A1型2例,A2型2例,A3型3例,B1型3例,B2型5例,B3型4例,C1型4例,C2型2例,C3型3例。骨折分别用钛板螺钉或交锁髓针固定。术后第3天开始用CPM机被动锻炼膝关节。术后随访6个月～6年,平均随访24个月,取得良好效果。结果根据Matta影像学评分,股骨解剖复位20例,满意复位7例,不满意复位1例。胫骨骨折解剖复位22例,满意复位5例,不满意复位1例。腓骨骨折行固定的16例中,解剖复位14例,满意复位2例。未固定的12例中解剖复位2例,满意复位4例,不满意复位6例。骨折愈合时间为8～25个月,平均愈合时间16个月,3例胫骨骨折及1例股骨骨折不愈合,经植骨后愈合,1例股骨钛板断裂,经改为交锁髓针固定植骨,骨折愈合。闭合性骨折切口均甲级愈合,9例小腿开放性骨折,6例甲级愈合,2例伤口愈合不良,经换药1个月伤口愈合,1例出现皮肤坏死,胫骨外露,给予皮瓣转移覆盖创面,伤口愈合。股骨4例开放性骨折,3例伤口愈合良好,1例伤口出现脂肪液化,愈合不良,经换药及局部理疗等治疗,伤口愈合。按Judet的疗效标准评价膝关节功能,优12例,良10例,可4例,差2例,优良率78.5%。结论把握好手术时机,选择适当的骨折内固定物,术后用CPM机被动锻炼膝关节,能够提高疗效,最大限度恢复肢体功能。

Objective To summarize the ipsilateral femur fracture of tibia and fibula of the surgical techniques and treatment.Methods From 2003～2009 a total of 28 cases of surgery for hip fracture according to AO classification,A1：5 cases,A2：4 cases,A3：3 cases,B1：4 cases,B2：4 cases,B3：2 cases,C1：3 cases,C2：2 cases,C3：1 case.Tibia and fibula fracture according to AO classification：A1：2 cases,A2：2 cases,A3：3 cases,B1：3 cases,B2：5 cases,B3：4 cases,C1：4 cases,C2：2 cases,C3：3 cases.Titanium screws were used to fracture or spinal cord locking pin fixed.3 days after starting training with passive knee CPM machine.All cases were followed up for 6 months～6 years,mean follow-up of 24 months and achieved good results.Results According to the Matta imaging score,femoral anatomic reduction in 20 cases,satisfactory reduction in 7 cases,unsatisfactory reduction in 1 case.Tibial fractures by anatomic reduction in 22 cases,satisfactory reduction in 5 cases,1 case of unsatisfactory reduction.Fibula fracture fixation in 16 cases,anatomical reduction in 14 cases,satisfactory reduction in 2 cases.Not satisfied with a fixed reduction of 12 cases in 4 cases,anatomioal reduction in 2 cases,unsatisfactory reduction in 6 cases.Fracture healing time was 8～25 months,the average healing time of 16 months.3 cases of tibial fracture and 1 femur fracture healing by bone graft healing,1 case of plate fracture of femur,by change marrow needle locking fixation and fracture healing.Closed fracture incision healed leg fracture in 9 cases,6 cases healed well,two cases of wound healing through wound healing dressing 1 month,1 case of skin necrosis,tibia bone exposure,for skin flap cover the wound surface,wound healing.Open fracture of the femur in 4 cases,3 cases of wound healing,1 case of wound fat liquefaction occurred,healing,by dressing and local physical therapy and other treatment,wound healing.Judetevaluate the efficacy of knee function,excellent in 12 cases,good in 10 cases,4 cases and poor in 2 cases,good rate of 78.5%.Conclusion grasp the timing of surgery,choose the appropriate fracture fixation,with a CPM machine after knee passive exercise,can improve efficacy,to maximize restoration of limb function.