股骨侧LISS钢板与逆行髓内钉治疗浮膝损伤的疗效比较

Comparison of Therapeutic Effect in Floating Knee Treated with Femoral LISS and Retrograde Nail

目的探讨LISS钢板治疗浮膝损伤的疗效,并与逆行髓内钉固定(RFN)方法在术后功能评价方面作比较。方法回顾性分析自2002年1月～2006年10月期间手术的59例浮膝损伤患者。股骨侧采用LISS钢板或RFN固定,胫骨侧根据骨折类型采用LISS钢板、髓内钉、4.5mmT型钢板、高尔夫钢板或3.5mm LCDCP钢板等内固定方式。依据股骨侧内固定方式不同,分为RFN组38例和LISS组21例,比较两组Karlstrom功能评价。结果 59例患者平均随访26个月,RFN与LISS组的功能评价优良率分别为76.3%和80.9%,两组差异无统计学意义;其中Ⅱ型浮膝损伤优良率分别为61.1%和78.6%,差异无统计学意义。结论虽尚不能认为LISS钢板治疗浮膝损伤的功能评分优于RFN,但其处理累及关节面的Ⅱ型浮膝损伤时具有较好的优势,且无髓内手术的二次打击,是更为可靠的内固定选择方案。

Objective To investigate features of floating knee treated with LISS on femoral side,and compare with evaluation of retrograde femoral nail（RFN） in postoperative functional results.Methods From January 2002 to October 2006,59 cases of floating knees operated in our hospital were retrospectively analyzed.Femoral fractures were fixed with LISS or RFN,while tibia side were fixed with LISS,intramedullary nail,4.5 mm T shape plate,Golf plate or 3.5 mm LCDCP.According to femoral fixation method,two groups of LISS and RFN,respectively included 21 and 38 cases,were comparatively evaluated by Karlstrom functional evaluation system.Results Mean follow-up of 59 cases was 26 months,excellent-good rates were respective 76.3% and 80.9%,there were no significant difference between two groups;while excellent-good rates of type Ⅱ were 61.1% and 78.6% without significant difference yet.Conclusion Though no evidence can prove that LISS may produce better functional results than RFN in treatment of floating knee,but it is reliable methods because of no second hit of intramedullary operation and appropriate features in treatment of type Ⅱ floating knee.