股骨远端复杂骨折的内固定方式选择

Internal fixation treatment mode choices for the complex distal femoral fractures

目的比较股骨远端复杂骨折2种不同内固定方式的疗效和适应证。方法 2006年1月至2009年3月,分别采用2种内固定方法治疗成年股骨远端复杂骨折46例,男28例,女18例,年龄26～71岁,平均42.9岁。其中逆行交锁髓内钉固定组20例,加压锁定钢板内固定组26例。X线片按AO/ASIF分型,均属复杂类型骨折(A3、C2、C3型)。结果入选病例均获随访16～36个月,平均24个月。切口I期愈合,复位满意,无术后感染、内固定物断裂、骨不连、深静脉血栓、肢体短缩、膝内翻畸形等并发症。骨折愈合时间为15～20周,A组平均18.18周,B组平均18.38周,两组间比较差异无统计学意义(P>0.05)。膝关节功能按Merchan评分标准评估,A组:优11例,良6例,可2例,差1例,优良率达85.0%。B组:优15例,良8例,可2例,差1例,优良率达88.5%。两组间比较差异有统计学意义(P<0.05)。结论对于股骨远端的复杂类型骨折,逆行交锁髓内钉和加压锁定钢板均能达到良好的疗效。但观测的结果显示,加压锁定钢板系统能最大限度地减少软组织损伤,对膝关节功能的恢复要优于逆行交锁髓内钉系统。

Objective To compare the efficacy and indication of the two different kinds of internal fixation treatment modes for the complex distal femoral fractures.Methods Reviewing the clinical data of 46 cases used two kinds of internal surgical treatment of complex distal femoral fracture during Jan 2006 to Mar 2009.These cases including 28 males and 18 females with an average age of 42.9-year-old ranging from age 26~71 years were divided into 2 groups：retrograde intramedullary nail group（A-Group,20 cases）;pressure locking plate fixation group（B-Group,26 cases）.There were all complex fracture types according X-ray film by AO/ASIF classification（A3、C2、C3）.Results All patients were followed up for 16~36 months（average 24 months）and obtained first intention incisions healing and satisfied replacement without complications such as postoperative infection,implant rupture,nonunion of bone,deep vein thrombosis,limb shortening,varus deformity.Fracture healing time was 15~20 weeks,the A-Group in average 18.18 weeks and the B-Group in average 18.38 weeks,between the two groups showed no significant difference（P0.05）.Postoperative knee scoring according to merchan system.A-Group：excellent in 11 cases,better in 6 cases,good in 2 cases and poor in 1 case,fine rate was 85.0%.B-Group：excellent in 15 cases,better in 8 cases,good in 2 cases and poor in 1 case,fine rate was 88.5%.Difference between the two groups was statistically significant（P0.05）.Conclusion For the complex distal femur fractures,retrograde intramedullary locking nail and compression plate could achieve good results.However,the results of our observations,using locking compression plate system could to minimize soft tissue damage,the recovery of knee function seems better than using retrograde intramedullary nail system.