髌旁微创逆行置入交锁髓内钉治疗老年股骨远端骨折

Minimal Invasive Insertion of Retrograde Nail for Elderly Distal Femoral Fractures

目的探讨经髌旁微创逆行置入交锁髓内钉治疗老年股骨远端骨折的方法并评价疗效。方法自2002年6月～2008年4月,笔者采用髌旁微创逆行置入交锁髓内钉治疗28例股骨远端骨折,于髌旁内侧作2～3 cm切口,膝关节屈曲显露股骨髁间窝,后交叉韧带止点前方8～10 mm处开口,沿髓腔方向扩髓后置入髓内钉。结果 24例获得12～36个月(平均19.4个月)随访。术后X线片证实所有骨折均骨性愈合,平均愈合时间为14周。根据Neer评分:膝关节功能优良率83.3%,平均活动度116°。随访未发现切口感染、髓内钉断裂、再发骨折及创伤性髌股关节炎。结论逆行交锁髓内钉是治疗老年股骨远端骨折的有效方法,应用CPM对恢复关节功能有重要作用,经髌旁微创置入可大大提高手术效率。

Objective To introduce and evaluate the results of minimal invasive insertion of retrograde nail for elderly distal femoral fractures. Methods Minimal invasive insertion of retrograde nail was performed from June 2002 to April 2008 on 28 eases of distal femoral fracture. A 2-3 em parapatellar incision was used to expose intercondylar notch. The retrograde nail was inserted from entry point anterior to the origin of the PCL. Results Twenty four patients were followed up for an average of 19.4 months （range, 12 to 36 months）. Radiography showed all fractures healed. The average time for bone healing was 14 weeks. The rate of excellent and good clinical results was 83.3% according to Neer score. The average knee motion was 116~. No complications like wound infection, fixation failure and traumatic patellofemoral arthritis were found. Conclusion The elderly distal femoral fractures could be effectively treated by minimal invasive insertion of retrograde nail combined with CPM.