股骨远端骨折手术治疗的多中心回顾性研究

Treatment of distal femoral fractures with open reduction and internal fixation： a multicentre retrospective investigation

目的通过多中心回顺性研究探讨采用切开复位内固定手术治疗股骨远端骨折的疗效。方法对自2002年10月至2009年3月国内4所大学附属医院收治且获得完整随访的60例股骨远端骨折患者资料进行回顾性分析，男37例，女23例；年龄15～90岁，平均49岁。所有患者均采用切开复位内固定治疗，微创内固定系统（LISS）固定29例，非LISS固定31例。骨折按照AO分型：A型20例，B型17例，C刑23例。对患者的疼痛视觉模拟评分（VAS）、膝关节功能评分、主观满意度等进行评估。比较患侧和健侧的膝关节手动活动范围，比较不同内固定系统与不同骨折分型患者的疗效。结果所有患者术后获4～74个月（平均26．2个月）随访，末次随访时骨折均获骨性愈合。所有患者骨折部位静态状态的VAS评分平均为0．35分，负重行走时的VAS评分为1．06分。HSS评分平均为81．8分，Lysholm评分平均83．4分。主观满意度评分为7～10分，平均8．9分。所有患者术后患侧和健侧膝关节平均活动范围比较，差异有统计学意义（P〈0．05）。LISS组与非LISS组仅HSS评分比较差异有统计学意义（P〈0．05）。不同骨折类型之间患膝屈曲角度A、B型均优于C型；屈曲改善角度C型〉B型〉A犁，差异均有统计学意义（P〈0．05）。结论根据具体骨折情况采用适当的切开复位内固定治疗股骨远端骨折疗效满意；使用LISS系统与非LISS系统差别不大。

Objective To retrospectively investigate the clinical outcomes of muhicentre treatment of distal femoral fractures with open reduction and internal fixation （ORIF） . Methods Included in this investigation were 60 patients with distal femoral fracture who were treated with ORIF from October 2002 to March 2009 and were fully followed up in 4 major Chinese medical institutions. They were 37 men and 23 women, aged from 15 to 90 years （mean, 49 years）. By AO classification, there were 20 cases of type A, 17 cases of type B and 23 cases of type C. Less Invasive Stabilization System （LISS） was used for fixation in 29 cases and non-LISS in 31 cases. The pain was nmasured by visual analogue scale （VAS）. The ranges of motion （ROMs） were compared between the affected and the normal knees. Results The follow-ups ranged from 4 to 74 months, averaging 26.2 months. All patients obtained clinical union by the end of follow-up. The mean VAS score was 0.35 when the fracture site was at rest and was 1.06 when the patient was walking under weight. The mean HSS score was 81.8, the mean Lysholm score was 83.4, and the subjective satisfaction of the patient averaged 8.9 （7 to 10）. The postoperative ROMs differed significantly between the affected and the normal knees （ P 〈 0.05）. The HSS scores differed significantly between LISS and non-LISS fixations （ P 〈 0. 05） . Fractures of types A and B had significantly better flexion of the affected knee than those of type C. Type C had significantly greater flexion improvement than type B and type B larger than type A （ P 〈 0.05）. Conclusions Current clinical treatments of distal femoral fractures by ORIF are satisfaetm7. There are no significant differences between LISS and non-LISS in overall clinical effects.